血液椎体骨髓炎的住院死亡率

A. Bazarov, K. S. Sergeyev, A. O. Faryon, R. V. Paskov, I. Lebedev
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摘要

目标。分析血液性椎体骨髓炎患者的致死结局。材料和方法。研究设计:回顾性分析医疗记录。分析2006-2017年209例住院血液性椎体骨髓炎患者的病历。其中68例(32.5%)采用保守治疗,141例(67.5%)采用手术治疗。研究了不同治疗方法致死性结局的危险因素,并进行了统计分析。住院死亡率(n = 9)为4.3%。住院死亡患者平均诊断时间缩短4倍(p = 0.092)。影响死亡的主要因素为糖尿病(p = 0.033)、Pola分型C型病变(p = 0.014)和年龄≥70岁(p = 0.006)。为了评估住院死亡率与组间差异之间的关系,进行了回归分析,结果显示与死亡率相关的因素是Pola C.4型病变(OR 9.73;95% CI 1.75-54.20),糖尿病(OR 5.86;95% CI 1.14-30.15)和年龄超过70岁(OR 12.58;95% ci 2.50-63.34)。这些因素的组合增加了住院死亡率的可能性(p = 0.001)。采用ROC曲线计算灵敏度(77.8%)和特异度(84.2%)。死亡率组共病指数(CCI)显著高于无死亡率组(p = 0.002)(≥4)。CCI大于等于4时,住院死亡的概率显著增加(or 10.23;95% CI 2.06 ~ 50.82), p = 0.005。长期死亡率为4.3% (n = 9), 77.8%的病例为急性心血管病,未发现椎体骨髓炎复发。住院死亡率为4.3%,保守治疗的患者无死亡率。糖尿病为主要危险因素,Pola为C型病变,年龄大于70岁。这些因素之间存在显著的相互负担(p = 0.001)。CCI≥4时,死亡概率较高(p = 0.005)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hospital mortality in hematogenous vertebral osteomyelitis
Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).
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