脊椎骨髓炎的早期和晚期死亡率：谁在确诊后的第一年内死亡。
Early and late mortality in vertebral osteomyelitis: who dies within the first year after diagnosis.
作者信息
Kernich Nikolaus, Abi-Chokami Arian, Jung Norma, Jochimsen Dorothee, Sircar Krishnan, Hoffmann Ada Marie, Meuser Stefan, Eysel Peer, Weber Carolyn, Vinas-Rios Juan Manuel, Yagdiran Ayla, Jung Norma, Yagdiran Ayla, Kernich Nikolaus, Sircar Krishnan, Fischer Julia, Jochimsen Dorothee, Weber Carolyn, Meyer-Schwickerath Charlotte
机构信息
Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
Division of Infectious Diseases, Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
出版信息
Infection. 2025 May 9. doi: 10.1007/s15010-025-02541-9.
OBJECTIVE
Vertebral osteomyelitis (VO) is a severe clinical entity associated with high mortality rates, especially within the first year after diagnosis. The aim of this single-center prospective cohort study was to identify and compare predictive factors influencing early and late mortality in patients with conservatively and surgically treated VO.
METHODS
We conducted a single-center prospective cohort study including patients treated for VO between 2008 and 2020 in a tertiary center in Germany to determine early (death within 30 days after diagnosis) and late mortality (death between day 31 and 365 after diagnosis). Additionally, multivariable analyses were performed to analyze predictive risk factors for early and late mortality.
RESULTS
A total of 323 patients were included. 19% died within the first year after diagnosis. Early mortality occurred in 5% and late mortality in 14% of cases. Multivariable analysis revealed chronic kidney disease (CKD) (OR: 13.2, 95% CI 5.7-30.3; p < 0.001) and MSSA (OR: 4.0, 95% CI 1.4-11.1; p = 0.008) as independent risk factors for early mortality, whereas ASA score > 2 (HR: 5.2, 95% CI 2.6-10.6; p < 0.001), age > 70 years (HR: 2.4, 95% CI 1.6-3.7; p < 0.001), CKD (HR: 1.9, 95% CI 1.3-3.0; p = 0.003) and bacteremia (HR: 1.8, 95% CI 1.2-2.7; p = 0.002) were identified as independent risk factors for late mortality.
CONCLUSION
One out of five VO patients dies within the first year after diagnosis. Risk factors for mortality within the first year include CKD and bacteremia. As a consequence in particular those patients should be closely monitored within the first year after.
目的
椎体骨髓炎（VO）是一种严重的临床病症，死亡率较高，尤其是在诊断后的第一年。本单中心前瞻性队列研究的目的是识别和比较影响保守治疗和手术治疗的VO患者早期和晚期死亡率的预测因素。
方法
我们进行了一项单中心前瞻性队列研究，纳入了2008年至2020年在德国一家三级中心接受VO治疗的患者，以确定早期（诊断后30天内死亡）和晚期死亡率（诊断后第31天至365天之间死亡）。此外，进行多变量分析以分析早期和晚期死亡率的预测风险因素。
结果
共纳入323例患者。19%在诊断后的第一年内死亡。5%的病例发生早期死亡，14%的病例发生晚期死亡。多变量分析显示，慢性肾脏病（CKD）（比值比：13.2，95%置信区间5.7 - 30.3；p < 0.001）和甲氧西林敏感金黄色葡萄球菌（MSSA）（比值比：4.0，95%置信区间1.4 - 11.1；p = 0.008）是早期死亡的独立危险因素，而美国麻醉医师协会（ASA）评分>2（风险比：5.2，95%置信区间2.6 - 10.6；p < 0.001）、年龄>70岁（风险比：2.4，95%置信区间1.6 - 3.7；p < 0.001）、CKD（风险比：1.9，95%置信区间1.3 - 3.0；p = 0.003）和菌血症（风险比：1.8，95%置信区间1.2 - 2.7；p = 0.002）被确定为晚期死亡的独立危险因素。
结论
五分之一的VO患者在诊断后的第一年内死亡。第一年内死亡的危险因素包括CKD和菌血症。因此，特别是这些患者在诊断后的第一年内应密切监测。
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