Abstract
BackgroundPatients with end-stage renal disease (ESRD) under hemodialysis (HD) are at greater risks of infectious spondylitis (IS), but there is no reliable predictor that facilitate early detection of this relatively rare and insidious disease.MethodsA retrospective review of the medical records from patients with ESRD under HD over a 12-year period was performed at a tertiary teaching hospital, and those with a first-time diagnosis of IS were identified. A 1:4 propensity score-matched case-control study was carried out, and baseline characteristics, underlying diseases, and laboratory data were compared between the study group and the control group, one month before the date of diagnosis or the index date respectively.ResultsA total of 16 patients with IS were compared with 64 controls. After adjustment, recent access operation (odds ratio [OR], 13.27; 95% confidence interval [CI], 3.53 to 49.91; p < 0.001), degenerative spinal disease (OR, 12.87; 95% CI, 1.89 to 87.41; p = 0.009), HD through a tunneled cuffed catheter (OR, 6.75; 95% CI, 1.74 to 26.14; p = 0.006), low serum levels of hemoglobin, albumin, as well as high levels of red blood cell volume distribution width (RDW), alkaline phosphatase (ALP), and high sensitivity C-reactive protein were significant predictors for a IS diagnosis one month later. Receiver operating characteristic curves for hemoglobin, RDW, ALP, and albumin all showed good discrimination. The further multivariate models identified both high serum ALP levels and low serum RDW levels following a recent access intervention in patients with relatively short HD vintages may be indicative of the development of IS.ConclusionPatients under HD with relatively short HD vintages showing either elevated ALP levels or low RDW levels following a recent access intervention should prompt clinical awareness about IS for timely diagnosis.
Highlights
Patients with end-stage renal disease (ESRD) under hemodialysis (HD) are at greater risks of infectious spondylitis (IS), but there is no reliable predictor that facilitate early detection of this relatively rare and insidious disease
Because most IS cases were believed to be predisposed by bacteremia, the reported risk factors were statuses related to suboptimal immunity, including old age, diabetes mellitus (DM), chronic kidney disease (CKD) and other immunocompromising conditions [4, 5]
For each patient in the study group, 4 controls were matched by propensity score by age, gender, and status of DM
Summary
Patients with end-stage renal disease (ESRD) under hemodialysis (HD) are at greater risks of infectious spondylitis (IS), but there is no reliable predictor that facilitate early detection of this relatively rare and insidious disease. Because most IS cases were believed to be predisposed by bacteremia, the reported risk factors were statuses related to suboptimal immunity, including old age, diabetes mellitus (DM), chronic kidney disease (CKD) and other immunocompromising conditions [4, 5]. Any direct route into the bloodstream raises the risk of systemic bacterial infection. These risk factors synergistically contribute to the morbidity and mortality of patients with end-stage renal disease (ESRD). Patients with ESRD under hemodialysis (HD) are under constant risk of developing IS and require clinical attention
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