Lu Yueh-An, Chen Chao-Yu, Kuo George, Yen Chieh-Li, Tian Ya-Chung, Hsu Hsiang-Hao
Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Int J Gen Med. 2022 Mar 14;15:2991-3001. doi: 10.2147/IJGM.S348431. eCollection 2022.
The incidence of bloodstream infection among end-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) was 26-fold higher than population controls, causing higher morbidity and costs. The aim of this investigation was to clarify the prognostic factors, in-hospital outcomes and recurrence of infectious spondylitis of patients with and without chronic HD.
This nationwide study analyzed 2592 patients who admitted for first-time infectious spondylitis between January 1, 2003, and December 31, 2015. Patients were classified into the chronic HD or the non-HD group. The logistic regression model and the general linear model were utilized to determine the impact of chronic HD on in-hospital mortality and recurrence. The Cox proportional hazard model was used to estimate the predictive factors of in-hospital mortality and recurrence.
Compared to the non-HD group, patients in the chronic HD group had a higher risk of respiratory failure, sepsis, in-hospital mortality, longer hospital stay, and higher medical spending. Chronic HD was an independent risk factor for in-hospital mortality (hazard ratio 2.21, 95% confidence interval 1.34-3.65, =0.0019), but not for recurrence. Intravascular device implantation or revision was a prognosticator for the mortality of both groups and a predictor for recurrence of the non-HD group. Surgical treatment was associated with a decreased risk of recurrence, whereas treatment with CT-guided abscess drainage was associated with an increased risk of recurrence in both groups.
Patients with infectious spondylitis who were receiving chronic HD had a higher in-hospital mortality compared to those without HD. Intravascular device implantations or revision within 6 months was a significant predictor of in-hospital mortality and disease recurrence. Surgical treatment of infectious spondylitis had a lower risk of recurrence than those with CT-guided abscess drainage in both patient groups.
接受慢性血液透析（HD）的终末期肾病（ESKD）患者发生血流感染的几率比普通人群高26倍，导致更高的发病率和成本。本研究的目的是阐明有无慢性血液透析的感染性脊柱炎患者的预后因素、住院结局及复发情况。
这项全国性研究分析了2003年1月1日至2015年12月31日期间首次因感染性脊柱炎入院的2592例患者。患者被分为慢性血液透析组或非血液透析组。采用逻辑回归模型和一般线性模型来确定慢性血液透析对住院死亡率和复发的影响。采用Cox比例风险模型来估计住院死亡率和复发的预测因素。
与非血液透析组相比，慢性血液透析组患者发生呼吸衰竭、脓毒症、住院死亡率的风险更高，住院时间更长，医疗费用更高。慢性血液透析是住院死亡率的独立危险因素（风险比2.21，95%置信区间1.34 - 3.65，P = 0.0019），但不是复发的危险因素。血管内装置植入或翻修是两组患者死亡率的预后因素，也是非血液透析组复发的预测因素。手术治疗与复发风险降低相关，而CT引导下脓肿引流治疗与两组患者的复发风险增加相关。
与未接受血液透析的感染性脊柱炎患者相比，接受慢性血液透析的患者住院死亡率更高。6个月内进行血管内装置植入或翻修是住院死亡率和疾病复发的重要预测因素。在两组患者中，感染性脊柱炎的手术治疗复发风险低于CT引导下脓肿引流治疗。
