Maneiro Jose R, Souto Alejandro, Cervantes Evelin C, Mera Antonio, Carmona Loreto, Gomez-Reino Juan J
Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain.
Department of Medicine, Medical School, Universidad de Santiago de Compostela, Santiago, Spain.
Clin Rheumatol. 2015 Nov;34(11):1961-7. doi: 10.1007/s10067-014-2844-3. Epub 2014 Dec 13.
The aims of this study are to analyse the characteristics of septic arthritis stratified by age and to identify the predictors of treatment failure and mortality in septic arthritis. A retrospective single-centre study was conducted in patients with native septic arthritis between 1994 and 2012. The primary outcome was treatment failure. Secondary outcomes included mortality, complications, endocarditis, bacteraemia, hospital readmission and the duration of the hospital stay. Logistic regression analyses with a propensity score were performed to identify the predictors of response and mortality. Additional analyses were performed according to age and the initial treatment (surgery or conservative). A total of 186 patients were studied. The median (interquartile range) age was 64 (46, 74) years, and the percentage of male patients was 68.9%. A logistic regression analysis showed that Staphylococcus aureus infection [OR 2.39 (1.20-4.77), p = 0.013], endocarditis [OR 4.74 (1.16-19.24), p = 0.029] and the involvement of joints difficult to access with needle drainage [OR 2.33 (1.06-5.11), p = 0.034] predict treatment failure and that age [OR 1.27 (1.07 = 1.50), p = 0.005], the leucocyte count at baseline [OR 1.01 (1.00-1.02), p = 0.023], bacteraemia [OR 27.66 (1.39-551.20), p = 0.030], diabetes mellitus [OR 15.33 (1.36-172.67), p = 0.027] and chronic renal failure [OR 81.27 (3.32-1990.20), p = 0.007] predict mortality. No significant differences in treatment failure by age were found. In septic arthritis, the predictors of mortality and the predictors of treatment failure differ. The predictors of treatment failure concern local factors and systemic complications, whereas conditions related to the host's immune competence, such as age and comorbidities that hamper the host's response, predict mortality.
本研究的目的是分析按年龄分层的脓毒性关节炎的特征，并确定脓毒性关节炎治疗失败和死亡的预测因素。对1994年至2012年间患有原发性脓毒性关节炎的患者进行了一项回顾性单中心研究。主要结局是治疗失败。次要结局包括死亡率、并发症、心内膜炎、菌血症、再次入院和住院时间。采用倾向评分进行逻辑回归分析，以确定反应和死亡的预测因素。根据年龄和初始治疗（手术或保守治疗）进行了额外的分析。共研究了186例患者。中位（四分位间距）年龄为64（46，74）岁，男性患者比例为68.9%。逻辑回归分析显示，金黄色葡萄球菌感染[比值比2.39（1.20 - 4.77），p = 0.013]、心内膜炎[比值比4.74（1.16 - 19.24），p = 0.029]以及针吸引流难以到达的关节受累[比值比2.33（1.06 - 5.11），p = 0.034]可预测治疗失败，而年龄[比值比1.27（1.07 = 1.50），p = 0.005]、基线白细胞计数[比值比1.01（1.00 - 1.02），p = 0.023]、菌血症[比值比27.66（1.39 - 551.20），p = 0.030]、糖尿病[比值比15.33（1.36 - 172.67），p = 0.027]和慢性肾衰竭[比值比81.27（3.32 - 1990.20），p = 0.007]可预测死亡。未发现年龄对治疗失败有显著差异。在脓毒性关节炎中，死亡的预测因素和治疗失败的预测因素不同。治疗失败的预测因素涉及局部因素和全身并发症，而与宿主免疫能力相关的状况，如年龄和妨碍宿主反应的合并症，则可预测死亡。
