Risk Factors for the In-Hospital Mortality in Pyogenic Vertebral Osteomyelitis: A Cross-Sectional Study on 9753 Patients

Abstract

Background: Pyogenic vertebral osteomyelitis represents a clinical challenge associated with significant morbidity and mortality. The aim of this study was to analyze potential risk factors for the in-hospital mortality of vertebral osteomyelitis (VO) patients. Methods: Based on the International Classification of Diseases, 10th Revision (ICD-10) codes for VO (“M46.2-”, “M46.3-”, and “M46.4-”) data for total case numbers, secondary diagnoses, and numbers of in-hospital deaths were extracted from the Institute for the Hospital Remuneration System (InEK GmbH). Odds ratios (OR) for death were calculated for several secondary diseases and factors of interest. Results: Despite age, certain comorbidities were found to be strongly associated with increased mortality risk: Heart failure (OR = 2.80; 95% CI 2.45 to 3.20; p < 0.01), chronic kidney disease (OR = 1.83; 95% CI 1.57 to 2.13; p < 0.01), and diabetes with complications (OR = 1.86; 95% CI 1.46 to 2.38; p < 0.01). Among the complications, acute liver failure showed the highest risk for in-hospital mortality (OR = 42.41; 95% CI 23.47 to 76.62; p < 0.01). Additionally, stage III kidney failure (OR = 9.81; 95% CI 7.96 to 12.08; p < 0.01), sepsis (OR = 5.94; 95% CI 5.02 to 7.03; p < 0.01), acute respiratory failure (OR = 5.31; 95% CI 4.61 to 6.12; p < 0.01), and systemic inflammatory response syndrome (SIRS) (OR = 5.19; 95% CI 3.69 to 5.19; p < 0.01) were associated with in-hospital mortality. When analyzing the influence of pathogens, documented infection with Pseudomonas aeruginosa had the highest risk for mortality (OR = 2.74; 95% CI 2.07 to 3.63; p < 0.01), followed by Streptococci, Escherichia coli, and Staphylococcus aureus infections. Conclusions: An early assessment of individual patient risk factors may be beneficial in the care and treatment of VO to help reduce the risks of mortality. These findings emphasize the importance of closely monitoring VO patients with chronic organ diseases, early detection and treatment of sepsis, and tailored empirical antibiotic therapy. The identification of specific pathogens and antibiotic susceptibility testing should be prioritized to improve patient outcomes in this high-risk population.

Midterm survival and risk factor analysis in patients with pyogenic vertebral osteomyelitis: a retrospective study of 155 cases

“…Some studies focused on risk factors of in-hospital mortality after VO. Ziarko et al ( 13 ) analysed risk factor of 9,753 VO cases in Germany in 2020. Apart from age, several comorbidities were associated with an elevated risk of mortality.…”

“…Liver disease showed a clear association (OR = 2.20) but without significancy. In the literature, age and liver disease have already been described as risk factors for mortality ( 13 , 21 , 32 , 36 – 38 ). The mean age in our study is comparable with these studies.…”

“…Intravascular catheter-related infections are considered responsible for up to 34% of HAVO VO cases ( 45 ). Another study described S. aureus infections, the presence of gram-negative pathogens with higher mortality ( 13 , 36 , 43 ). In our cohort, infection with S. aureus as the only pathogen demonstrated a significantly higher risk of psoas abscess, a complication that could contribute to a severe course of the disease.…”

“…The treatment of elderly patients, who are particularly vulnerable to these infections, is becoming increasingly important due to epidemiological development and the growing prevalence of comorbidities in an aging population ( 12 ). Furthermore, secondary diagnoses contributing to frailty, such as liver cirrhosis, congestive heart failure, and kidney insufficiency requiring dialysis, have been associated with a higher risk ( 13 ). VO treatment also affects patients’ quality of life.…”