Identifying risk groups of infectious spondylitis in patients with end-stage renal disease under hemodialysis: a propensity score-matched case-control study

Abstract

Background 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. Methods A 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. Results A 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. Conclusion Patients 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. Electronic supplementary material The online version of this article (10.1186/s12882-019-1504-x) contains supplementary material, which is available to authorized users.

Discitis Following Radiofrequency Nucleoplasty: A Case Report

“…Previous studies showed that the most common discitis-related disease was diabetes mellitus in 18 patients (16.6%), followed by ESRD in 10 (9.25%) (14). A systematic review and other reports concluded that ESRD has a positive relationship with discitis through repeated vascular access (15,16). Uremia in ESRD may alter immune status characterized by immunodepression and increased likelihood of infection, especially in those undergoing a spine procedural intervention, as observed in the reported case (17).…”

Mortality, complication risks, and clinical outcomes after surgical treatment of spinal epidural abscess: a comparative analysis of patients aged 18–64 years, 65–79 years, and ≥ 80 years, with a 3-year follow-up

“…One potential explanation is that the aforementioned diseases lead to reduced immunocompetency; hence, the cellular immunity decreases, with reduced chemotaxis, phagocytosis, and bactericidal activity of neutrophilic granulocytes [ 23 ]. In addition, patients with chronic renal failure already have high levels of inflammatory markers in the blood due to the reduction in the number of T cells and cytokine levels; hence, a delayed or missed diagnosis might occur [ 24 ]. Therefore, when such patients visit the emergency unit, clinicians should be mindful of the fact that inflammatory processes are linked to an increased risk of spinal infection [ 25 ].…”

Surgical management of ventrally located cervical epidural abscess: A comparative analysis between patients aged 18–64 years and ≥65 years

“…Hence, a delayed reduction in the number of T cells and cytokine levels is observed as compared to younger patients who receive complete adult dosing. 19 …”