Lertudomphonwanit Thamrong, Somboonprasert Chirtwut, Lilakhunakon Kittiphon, Jaovisidha Suphaneewan, Ruangchaijatuporn Thumanoon, Fuangfa Praman, Rattanasiri Sasivimol, Watcharananan Siriorn, Chanplakorn Pongsthorn
Faculty of Medicine Ramathibodi Hospital, Department of Orthopaedics, Mahidol University, Bangkok, Thailand.
Sawangdaendin Crown Prince Hospital, Sakon Nakhon, Thailand.
PLoS One. 2023 Aug 18;18(8):e0290361. doi: 10.1371/journal.pone.0290361. eCollection 2023.
Microbiological diagnosis of tuberculous spondylodiscitis (TS) and pyogenic spontaneous spondylodiscitis (PS) is sometime difficult. This study aimed to identify the predictive factors for differentiating TS from PS using clinical characteristics, radiologic findings, and biomarkers, and to develop scoring system by using predictive factors to stratify the probability of TS.
A retrospective single-center study. Demographics, clinical characteristics, laboratory findings and radiographic findings of patients, confirmed causative pathogens of PS or TS, were assessed for independent factors that associated with TS. The coefficients and odds ratio (OR) of the final model were estimated and used to construct the scoring scheme to identify patients with TS.
There were 73 patients (51.8%) with TS and 68 patients (48.2%) with PS. TS was more frequently associated with younger age, history of tuberculous infection, longer duration of symptoms, no fever, thoracic spine involvement, ≥3 vertebrae involvement, presence of paraspinal abscess in magnetic-resonance-image (MRI), well-defined thin wall abscess, anterior subligamentous abscess, and lower biomarker levels included white blood cell (WBC) counts, erythrocyte-sedimentation-rate (ESR), neutrophil fraction, and C-reactive protein (all p < 0.05). Multivariate logistic regression analysis revealed significant predictors of TS included WBC ≤9,700/mm3 (odds ratio [OR] 13.11, 95% confidence interval [CI] 4.23-40.61), neutrophil fraction ≤78% (OR 4.93, 95% CI 1.59-15.30), ESR ≤92 mm/hr (OR 4.07, 95% CI 1.24-13.36) and presence of paraspinal abscess in MRI (OR 10.25, 95% CI 3.17-33.13), with an area under the curve of 0.921. The scoring system stratified the probability of TS into three categories: low, moderate, and high with a TS prevalence of 8.1%, 29.6%, and 82.2%, respectively.
This prediction model incorporating WBC, neutrophil fraction counts, ESR and presence of paraspinal abscess accurately predicted the causative pathogens. The scoring scheme with combination of these biomarkers and radiologic features can be useful to differentiate TS from PS.
结核性脊椎椎间盘炎（TS）和化脓性自发性脊椎椎间盘炎（PS）的微生物学诊断有时具有挑战性。本研究旨在利用临床特征、影像学表现和生物标志物确定区分TS与PS的预测因素，并通过使用预测因素建立评分系统来分层TS的可能性。
一项回顾性单中心研究。对确诊为PS或TS的病原体的患者的人口统计学、临床特征、实验室检查结果和影像学检查结果进行评估，以确定与TS相关的独立因素。估计最终模型的系数和比值比（OR），并用于构建评分方案以识别TS患者。
73例（51.8%）为TS患者，68例（48.2%）为PS患者。TS更常与年龄较轻、结核感染史、症状持续时间较长、无发热、胸椎受累、≥3个椎体受累、磁共振成像（MRI）显示椎旁脓肿、边界清晰的薄壁脓肿、前纵韧带下脓肿以及较低的生物标志物水平（包括白细胞（WBC）计数、红细胞沉降率（ESR）、中性粒细胞比例和C反应蛋白）相关（均p<0.05）。多因素逻辑回归分析显示，TS的显著预测因素包括WBC≤9700/mm³（比值比[OR]13.11，95%置信区间[CI]4.23 - 40.61）、中性粒细胞比例≤78%（OR 4.93，95%CI 1.59 - 15.30）、ESR≤92 mm/hr（OR 4.07，95%CI 1.24 - 13.36）以及MRI显示椎旁脓肿（OR 10.25，95%CI 3.17 - 33.13），曲线下面积为0.921。评分系统将TS的可能性分为低、中、高三个类别，TS患病率分别为8.1%、29.6%和82.2%。
该包含WBC、中性粒细胞比例计数、ESR和椎旁脓肿存在情况的预测模型准确预测了病原体。结合这些生物标志物和影像学特征的评分方案有助于区分TS与PS。
