18. 最初诊断为脊柱感染的患者的患病率和死亡率的独立预测因素

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100712

Jiunhuan Liau MD

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引用次数: 0

摘要

背景背景脊柱感染一直是世界范围内的一个新兴问题，因为它有可能导致危及生命的疾病，尽管与过去一样罕见，但脊柱炎每年的发病率仍为每10万名患者0.4-2例。目的：本研究的目的是关注无手术干预的脊柱感染的独立危险因素。研究设计/设置回顾性图表回顾显示，首次入院的脊柱感染患者，无论是保守的抗生素治疗还是随后的手术治疗，在患者出院后随访一年，不包括在诊断前一年内接受脊柱手术或抗生素治疗的患者。患者样本：2014年1月至2021年12月期间，共有340名在神经外科、感染科或骨科治疗的自发性脊柱炎患者参加了这项研究，这些患者接受了全面的临床评估、实验室检查、放射学研究和临床管理，表明根据个体采用了完整的医疗措施。在首次住院后的12个月内进行MRI检查以进行初步诊断。我们的主要终点是患者死亡率，次要终点是LOS。方法建立可能影响患者临床结果的因素预测模型。我们把病人分成两组死亡率组和存活率组。考虑了几个临床因素。结果40例（12%）患者在诊断后12个月内因感染死亡，其中5例接受手术治疗，生存组为97例。单变量logistic回归分析显示高血压（OR: 2.44 [1.21-4.91], p=0.013）、肾功能损害（OR: 2.97 [1.45-6.12], p=0.003）、无需手术干预（OR: 3.35 [1.27-8.00], p=0.014）、血红蛋白（OR: 0.77 [0.67-0.90], p= 0.001）、CRP （OR: 1.03 [0.99-1.07], p= 0.061）。多变量logistic回归分析（曲线下面积0.689）显示，肾功能损害（OR: 2.95 [1.39-6.27], p=0.005）、未手术干预（OR: 2.99 [1.11-8.07], p=0.030）是脊柱感染死亡的独立因素，BMI >；30、高血压、肾功能衰竭、营养不良往往是影响死亡率的候选因素。结论肾功能损害和手术干预是预测脊柱炎患者1年死亡率的独立因素，但仍有许多新的和潜在的因素被考虑，包括肥胖、病原体来源变异、营养不良和炎症因素。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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18. Prevalence and independent predictors of mortality in patients initially diagnosed with spinal infection

BACKGROUND CONTEXT

Spinal infection had been an emerging issue worldwide due to its potential of contributing to life-threatening disease, and though rare as it was in the past, spondylodiscitis still encountering with an incidence of 0.4-2 cases per 100,000 patients each year.

PURPOSE

The goal of this study is to focus on the independent risk factors for spinal infection without previous surgical intervention.

STUDY DESIGN/SETTING

A retrospective chart review revealed patients with initial admission of spinal infection whether treated by conservative antibiotics treatment or surgery thereafter, following for one year after the patients discharged from our ward, excluding the patients who had received spinal surgery or treated with antibiotics within one year before the diagnosis.

PATIENT SAMPLE

There were 340 patients enrolled to the study with spontaneous spondylodiscitis managed in the neurosurgery, infection, or orthopedic department during the period between January 2014 and December 2021, which had received full clinical assessment, laboratory test, radiological study, and clinical management, indicating intact medical remedies being applied based on the individuals. MRI was performed for the initial diagnosis and up to 12 months following the first hospitalization.

OUTCOME MEASURES

Our primary outcome is the patient mortality, secondary outcome is the LOS.

METHODS

We aim to issue a predictive model for the factors that potentially affect the clinical result of the patient. We had placed the patients into two groups the mortality one and the survival. Several clinical factors were considered.

RESULTS

Forty patients (12%) expired due to the infection within 12 months of diagnosis, of which 5 patients received surgical intervention compared to 97 patients for the survival group. Univariable logistic regression analysis demonstrated hypertension (OR: 2.44 [1.21-4.91], p=0.013), renal impairment (OR: 2.97 [1.45-6.12], p=0.003), without surgical intervention (OR: 3.35 [1.27-8.00], p=0.014), hemoglobin (OR: 0.77 [0.67-0.90], p= 0.001), CRP (OR: 1.03 [0.99-1.07], p= 0.061). while Multivariable logistic regression analysis (area under curve 0.689) demonstrated renal impairment (OR: 2.95 [1.39-6.27], p=0.005), without surgical intervention (OR: 2.99 [1.11-8.07], p=0.030) as the independent factors toward mortality for spinal infection, and furthermore, patients with BMI >30, hypertension, renal failure, poor nutrition had tend to be candidate of factors that influenced the mortality rate.

CONCLUSIONS

Impaired renal function and surgical intervention had been the independent predictors of one year mortality for the patients with spondylodiscitis, but still plenty of novel and potential factors were considered, including obesity, variant source of pathogen, poor nutrition and inflammation factors.