Neurosurgery Resident Physician Dell Medical School at The University of Texas at Austin
Introduction: Analyze outcomes of patients with hematogenous spinal osteomyelitis and develop a multivariate risk score to predict adverse outcomes, specifically sequelae. Additionally, the study sought to determine the impact of long-term antibiotic use, age, BMI, comorbidities, and spinal area on patient outcomes.
Methods: Multivariate logistic regression was employed to identify significant predictors of sequelae, and a risk score was developed based on the model coefficients. Risk score thresholds were optimized to balance sensitivity and specificity for predicting sequelae.
Results: The analysis included 98 patients, with a median age of 65 years. Comorbidities such as diabetes and cardiovascular disease were prevalent. Age, comorbidities, and pre-antibiotic use were found to be significant predictors of sequelae. Older patients had a higher likelihood of developing sequelae (coefficient: 0.1348), while higher BMI was associated with a slight protective effect (coefficient: -0.0723). The presence of comorbidities significantly increased the risk of sequelae (coefficient: 0.2976), and patients who received antibiotics prior to admission were at increased risk (coefficient: 0.5554), likely reflecting the severity of their condition. The multivariate risk score demonstrated strong predictive ability, and a threshold of 0.4 provided an optimal balance between sensitivity (65%) and specificity (85%). Patients classified as high-risk were more likely to develop sequelae, while those in the low-risk category had fewer complications. Long-term antibiotic use was associated with a slight reduction in mortality, from 8.7% to 4.4%, but did not significantly impact sequelae rates.
Conclusion : This study highlights the critical role of age, comorbidities, and pre-antibiotic use in determining outcomes for patients with hematogenous spinal osteomyelitis. The multivariate risk score developed provides a valuable tool for clinicians to stratify patients by risk and tailor their treatment approaches accordingly. Targeted management of high-risk patients, especially those with comorbidities and advanced age, along with early antibiotic intervention, may improve clinical outcomes. The slight reduction in mortality with long-term antibiotic use suggests a potential survival benefit for extended antibiotic therapy, but further research is required to understand the optimal duration and impact on long-term complications.
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