Zadran Spogmai, Pedersen Peter Heide, Eiskjær Søren
Aalborg University Hospital, Aalborg, Denmark.
Global Spine J. 2020 Jun;10(4):456-463. doi: 10.1177/2192568219862213. Epub 2019 Jul 10.
Retrospective cohort study.
To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO.
All patients with a diagnosis of VO in Region North Denmark from 2004 to 2014 were followed for at least 2 years or until death. They were all treated according to a standardized guideline for the choice of treatment modality. Nineteen dichotomized variables with possible influence on the mortality were registered for all patients in the study. LASSO (least absolute shrinkage and selection operator) penalized Cox regression analysis was used to build a predictive model for 2-year survival after VO.
A total of 125 patients were eligible for inclusion, mean age 67 years, 36 women. 75 were treated surgically. Twenty-one patients were dead 2 years after the diagnosis. Kaplan-Meier estimate of 2-year survival was 0.82 [0.75, 0.88]. Any difference in mortality between surgically and conservatively treated patients was nonsignificant at 1 and 2 years (univariate Cox regression analysis). Significant factors included in the predictive model after LASSO penalized Cox regression analysis was Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score. The area under the curve (AUC) for the predictive model ranged from 0.74 to 0.77.
Patients undergoing surgical management for vertebral osteomyelitis according to standardized and agreed-upon guidelines had no higher mortality than those allocated to conservative treatment. The predictive model included 5 variables associated with an increased mortality: CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score.
回顾性队列研究。
比较接受手术或保守治疗的椎体骨髓炎（VO）患者的死亡率，并构建VO后死亡率的预测模型。
对2004年至2014年丹麦北部地区所有诊断为VO的患者进行至少2年的随访或直至死亡。他们均按照治疗方式选择的标准化指南进行治疗。对研究中的所有患者记录了19个可能影响死亡率的二分变量。使用套索（最小绝对收缩和选择算子）惩罚的Cox回归分析构建VO后2年生存的预测模型。
共有125例患者符合纳入标准，平均年龄67岁，女性36例。75例接受了手术治疗。21例患者在诊断后2年死亡。2年生存率的Kaplan-Meier估计值为0.82[0.75,0.88]。手术和保守治疗患者在1年和2年时的死亡率差异无统计学意义（单变量Cox回归分析）。套索惩罚的Cox回归分析后预测模型中包含的显著因素有Charlson合并症指数（CCI）、心血管疾病、C反应蛋白（CRP）正常化、胸部感染和卡诺夫斯基评分。预测模型的曲线下面积（AUC）范围为0.74至0.77。
根据标准化且商定的指南接受手术治疗椎体骨髓炎的患者死亡率并不高于接受保守治疗的患者。预测模型包括与死亡率增加相关的5个变量：CCI、CRP正常化、心血管疾病、胸部感染和卡诺夫斯基评分。
