Heuer Annika, Strahl André, Viezens Lennart, Koepke Leon-Gordian, Stangenberg Martin, Dreimann Marc
Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
J Clin Med. 2022 Jan 27;11(3):660. doi: 10.3390/jcm11030660.
(1) Background: Patients with spondylodiscitis often present with unspecific and heterogeneous symptoms that delay diagnosis and inevitable therapeutic steps leading to increased mortality rates of up to 27%. A rapid initial triage is essential to identify patients at risk for a complicative disease course. We therefore aimed to develop a risk assessment score using fast available parameters to predict in-hospital mortality of patients admitted with spondylodiscitis. (2) Methods: A retrospective data analysis of 307 patients with spondylodiscitis recruited from 2013 to 2020 was carried out. Patients were grouped according to all-cause mortality. Via logistic regression, individual patient and clinical characteristics predictive of mortality were identified. A weighted sum score to estimate a patient's risk of mortality was developed and validated in a randomly selected subgroup of spondylodiscitis patients. (3) Results: 14% of patients with spondylodiscitis died during their in-hospital stay at a tertiary center for spinal surgery. Univariate and logistic regression analyses of parameters recorded at hospital admission showed that age older than 72.5 years, rheumatoid arthritis, creatinine > 1.29 mg/dL and CRP > 140.5 mg/L increased the risk of mortality 3.9-fold, 9.4-fold, 4.3-fold and 4.1-fold, respectively. detection increased the risk of mortality by 2.3-fold. (4) Conclusions: The novel Hamburg Spondylodiscitis Assessment Score (HSAS) shows a good fit identifying patients at low-, moderate-, high- and very high risk for in hospital mortality on admission (AUC: 0.795; < 0.001). The implementation of the HSAS into clinical practice could ease identification of high-risk patients using readily available parameters alone, improving the patient's safety and outcome.
(1) 背景：脊柱椎间盘炎患者常表现出非特异性和异质性症状，这会延迟诊断和必要的治疗步骤，导致死亡率增加，高达27%。快速的初始分诊对于识别有复杂病程风险的患者至关重要。因此，我们旨在开发一种风险评估评分，使用快速可得的参数来预测因脊柱椎间盘炎入院患者的院内死亡率。(2) 方法：对2013年至2020年招募的307例脊柱椎间盘炎患者进行回顾性数据分析。患者按全因死亡率分组。通过逻辑回归，确定预测死亡率的个体患者和临床特征。开发了一个加权总和评分来估计患者的死亡风险，并在随机选择的脊柱椎间盘炎患者亚组中进行验证。(3) 结果：14%的脊柱椎间盘炎患者在三级脊柱外科中心住院期间死亡。入院时记录参数的单变量和逻辑回归分析表明，年龄大于72.5岁、类风湿性关节炎、肌酐>1.29mg/dL和CRP>140.5mg/L分别使死亡风险增加3.9倍、9.4倍、4.3倍和4.1倍。检测使死亡风险增加2.3倍。(4) 结论：新的汉堡脊柱椎间盘炎评估评分（HSAS）在识别入院时院内死亡低、中、高和极高风险患者方面显示出良好的拟合度（AUC：0.795；<0.001）。将HSAS应用于临床实践可以仅使用容易获得的参数轻松识别高危患者，提高患者的安全性和治疗结果。
