The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

Abstract

(1) Background: Patients with spondylodiscitis often present with unspecific and heterogeneous symptoms that delay diagnosis and inevitable therapeutic steps leading to increased mortality rates of up to 27%. A rapid initial triage is essential to identify patients at risk for a complicative disease course. We therefore aimed to develop a risk assessment score using fast available parameters to predict in-hospital mortality of patients admitted with spondylodiscitis. (2) Methods: A retrospective data analysis of 307 patients with spondylodiscitis recruited from 2013 to 2020 was carried out. Patients were grouped according to all-cause mortality. Via logistic regression, individual patient and clinical characteristics predictive of mortality were identified. A weighted sum score to estimate a patient’s risk of mortality was developed and validated in a randomly selected subgroup of spondylodiscitis patients. (3) Results: 14% of patients with spondylodiscitis died during their in-hospital stay at a tertiary center for spinal surgery. Univariate and logistic regression analyses of parameters recorded at hospital admission showed that age older than 72.5 years, rheumatoid arthritis, creatinine > 1.29 mg/dL and CRP > 140.5 mg/L increased the risk of mortality 3.9-fold, 9.4-fold, 4.3-fold and 4.1-fold, respectively. S. aureus detection increased the risk of mortality by 2.3-fold. (4) Conclusions: The novel Hamburg Spondylodiscitis Assessment Score (HSAS) shows a good fit identifying patients at low-, moderate-, high- and very high risk for in hospital mortality on admission (AUC: 0.795; p < 0.001). The implementation of the HSAS into clinical practice could ease identification of high-risk patients using readily available parameters alone, improving the patient’s safety and outcome.

Diagnostic Sensitivity of Blood Culture, Intraoperative Specimen, and Computed Tomography-Guided Biopsy in Patients with Spondylodiscitis and Isolated Spinal Epidural Empyema Requiring Surgical Treatment

“…The diagnostic sensitivity of blood cultures in SD and ISEE patients varies widely from 30% to 78% according to previously published reports [12,16,17,[24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40]. However, a systematic review of 14 clinical retrospective studies found that blood cultures routinely obtained in 91% of cases had an average sensitivity of 58%, which is consistent with our results (57.2%) [16].…”

“…However, a systematic review of 14 clinical retrospective studies found that blood cultures routinely obtained in 91% of cases had an average sensitivity of 58%, which is consistent with our results (57.2%) [16]. The diagnostic sensitivity of image-guided biopsy ranges from 44.1% to 82.5% and can be increased by using different techniques such as X-ray or CT for sampling and different sites such as psoas, disc, or vertebral body [12,17,24,25,29,[36][37][38][39]. Consistent with this spectrum, we were able to detect a pathogen with CT-guided biopsies from psoas abscess in 55.7% of cases.…”

Case Report: Campylobacter fetus caused pyogenic spondylodiscitis with a presentation of cauda equina syndrome after instrumented lumbar fusion surgery

“…Evidence-based therapeutic concepts for infectious spondylodiscitis of the lumbar spine are still lacking (11). However, the latest publications discuss the rationale for using newly developed classification systems in improving the treatment of spondylodiscitis (12,13). CF-caused pyogenic spondylodiscitis is very rare, whereby reported cases predominantly occurred in high-risk patients, as did in our reported case, but contrary to our case, without previous instrumented lumbar fusion surgery (1-8).…”

“…Evidence-based therapeutic concepts for infectious spondylodiscitis of the lumbar spine are still lacking ( 11 ). However, the latest publications discuss the rationale for using newly developed classification systems in improving the treatment of spondylodiscitis ( 12 , 13 ).…”

Pyogenic spondylodiscitis in HIV-positive patients under antiretroviral therapy: A case series

“…Recently, a German group of researchers suggested a score for evaluation of mortality risk on hospital admission, the Hamburg Spondylodiscitis Assessment Score. 18 It takes age, C-reactive protein, kidney function, and pathogen into account. When retrospectively applying the score to our patients, the one who died was indeed classified as at a very high risk for mortality.…”