Treatment outcomes in patients with pyogenic vertebral osteomyelitis who have cirrhosis

• Published in: Scientific reports 2019-10, Vol.9 (1), p.15223-9, Article 15223
• Main Authors: Kim, Jihye, Kang, Ho Suk, Kim, Jeoung Woo, Kim, Seok Woo, Oh, Jae-Keun, Kim, Young-Woo, Park, Moon Soo, Kim, Tae-Hwan
• Format: Article
• Language: English
• Subjects: 692/499; 692/699/255/1318; Aged; Bacteremia; Cirrhosis; Diagnosis; Female; Humanities and Social Sciences; Humans; Liver cirrhosis; Liver Cirrhosis - complications; Magnetic resonance imaging; Male; Middle Aged; Mortality; multidisciplinary; Multivariate analysis; Osteomyelitis; Osteomyelitis - complications; Osteomyelitis - mortality; Osteomyelitis - surgery; Retrospective Studies; Risk groups; Science; Science (multidisciplinary); Spinal Diseases - complications; Spinal Diseases - mortality; Spinal Diseases - surgery; Treatment Outcome; Vertebrae; Vertebral osteomyelitis
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-51758-w

Early diagnosis and proper treatment of pyogenic vertebral osteomyelitis (PVO) in patients with cirrhosis is challenging to clinicians, and the mortality rate is expected to be high. A retrospective study was conducted to investigate the treatment outcome in PVO patients with cirrhosis and to identify the predictors of their mortality. Mortality was divided into two categories, 30-day and 90-day mortality. A stepwise multivariate logistic regression model was used to identify predictors of mortality. Eighty-five patients were identified after initial exclusion. The patients’ mean age was 60.5 years, and 50 patients were male. The early mortality rates within 30 and 90 days were 17.6% and 36.5%, respectively. Multivariate analysis revealed that increased age, CTP class C, and bacteremia at the time of PVO diagnosis were predictors of 30-day mortality, while higher MELD score, presence of combined infection, and multiple spinal lesions were predictors of 90-day mortality. Attention should be paid to the high mortality between 30 and 90 days after PVO diagnosis (18.8%), which was higher than the 30-day mortality. Liver function was consistently a strong predictor of mortality in PVO patients with cirrhosis. The high-risk patients should be targeted for an aggressive diagnostic approach, using spinal MRI and intensive monitoring and treatment strategies.