Treatment outcomes in patients with pyogenic vertebral osteomyelitis who have cirrhosis

Jihye Kim,Moon Soo Park,Jae-Keun Oh,Ho Suk Kang,Tae-Hwan Kim,Jeoung Woo Kim,Seok Woo Kim,Young-Woo Kim

doi:10.1038/s41598-019-51758-w

Abstract

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.

Highlights

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
As the first study to investigate the treatment outcome of PVO patients with cirrhosis, our study demonstrated that the 30- and 90-day mortality rates were 17.6% and 36.5%, respectively (Table 2)
Previous studies reported the early mortality of PVO patients, including in-hospital mortality or 90-day mortality ranging from 2.8% to 16.8%27–32

Summary

Introduction

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. Considering the greatly increased mortality from infection in patients with cirrhosis[2], early diagnosis and prompt treatments should be compulsory to save patients’ lives Adherence to such a basic principle for patients with cirrhosis is not easy for clinicians engaged in the treatment of pyogenic vertebral osteomyelitis (PVO). A retrospective study reported that 77% of patients with end-stage liver disease had bodily pain, in the abdomen, back, head/neck, and upper and lower extremities, within 24 hours of the evaluation, and most patients (90%) received various analgesics[5] Such a high prevalence of bodily pain in patients with cirrhosis prevents the use of the clinical symptoms of PVO as an indicator for early diagnosis. Under the expected higher mortality, prognostic studies to identify high-risk patients, on whom intensive monitoring and treatment strategies should be concentrated, are essential for the improvement of clinical outcome. We performed a retrospective study to investigate the treatment outcome in PVO patients with cirrhosis, and to identify the predictors of their mortality

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