Prevalence, risk factors of mortality, and clinical outcomes in patients with spontaneous spinal infection

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Methods: A retrospective chart review revealed patients with spinal infection following for one year, excluding the patients who had received spinal surgery before the diagnosis. There were 340 patients enrolled to the study with spontaneous spondylodiscitis during the period between January, 2014 and December, 2021, which had received full clinical assessment, laboratory test, radiological study and clinical management. MRI was performed for the initial diagnosis and up to 12 months of following. Results: Among the 340 patients with an average age of 63 years, 40 patients expired due to the infection within 12 months of diagnosis, of which 5 patients received surgical intervention compared to 97 patients for the survival group. Univariable logistic regression analysis demonstrated hypertension [OR: 2.44 (1.21-4.91), p = 0.013], renal impairment [OR: 2.97 (1.45-6.12), p = 0.003], without surgical intervention [OR: 3.35 (1.27-8.00), p = 0.014], hemoglobin [OR: 0.77 (0.67-0.90), p = 0.001], and CRP [OR: 1.03 (0.99-1.07), p = 0.061]. While multivariable logistic regression analysis demonstrated renal impairment [OR: 2.95 (1.39-6.27), p = 0.005], without surgical intervention [OR: 2.99 (1.11-8.07), p = 0.030] as the independent factors. Conclusions: Impaired renal function and surgical intervention were identified as predictors of one-year mortality in patients with spondylodiscitis. However, a number of additional novel and potentially important factors warrant consideration, including obesity, variations in pathogen source, poor nutritional status and inflammatory marks. Introduction Spinal infection had been an emerging issue worldwide due to its potential of contributing to life-threatening disease, and though rare as it was in the past, spondylodiscitis still encountering with an incidence of 0.4-2 cases per 100,000 patients each year [ 1 ] with a tendency of increasing due to the evolution of diagnostic equipment and treatment method recently, having a preponderance of patients with debilitating disease such as diabetes mellitus, chronic renal impairment, obesity, previous spinal surgery, and elderly [ 1 , 2 ] with an overall mortality rate lying between 4.5% and 11% according to the current study [ 2 , 3 , 4 ]. Although several predisposing factors had been issued as mentioned previously, we aim to focus on the variables which could facilitate the mortality, not being confined to spinal surgery which had long term been notorious for its crucial roles connecting with spinal infection (5), and that is, other factors would be treated equally as still possessing different contents of resulting in spondylodiscitis. Moreover, whether the patients present with obvious clinical symptoms such as pain of lower back or legs or not, which had been the most common symptoms among the spinal infection victims, there are still candidates for spondylodiscitis followed by some of the ordinary infectious signs such as fever, which had been noted approximately half of whom had diagnosed while admission with ambiguous infection source initially, and paresis, about one-third of the patients worldwide reported [ 9 , 10 , 11 ]. Due to the presentation with variability, early detection of the disease still meant to be a challenge and thus, early intervention should be taken into consideration. Materials and methods Data source This is a retrospective analysis in which 340 patients were enrolled to our study from January 1st, 2014 to December 31st, 2021 with the abstract of discharge note being reviewed since the administrative claim data from admission to the precise diagnosis while discharge. Several laboratory and clinical data was collected involving: age, sex, BMI, comorbidities at the time of admission, surgical intervention during hospitalization, ICD-10 revision code, length of stay, and in-hospital mortality. Moreover, infection related to spinal surgery was excluded from our study, for the sake of focusing on the spontaneous spondylodiscitis as which the clinical (fever, back pain, claudication, paralysis with lower limbs, presenting with wheelchair while arriving), history(previous blood stream or urinary infection, comorbidities such as chronic renal disease, cardiovascular events, hypertension, diabetes mellitus, obesity, etc.), laboratory(white blood cell, C-reactive protein, Erythrocyte sedimentation rate), and the image study (Computed tomography or Magnetic resonance imaging) were compatible for the diagnosis defined. As the surgical intervention (laminectomy, discectomy, and debridement) being one of the independent variables against mortality, confirmation of the exact culture data from the infectious site was not capable for all the patients, for among the surgeons from our faculty, indication or criteria for operation differs to each other but some of the absolute surgical indication was met as epidural abscess, progressed neurological deficit, spinal instability or deformity, or radiologic and clinical deterioration after long term antibiotics treatment, so empiric antibiotics was prescribed for the patient without surgery or CT-guided biopsy, and for those who had received the operation with the exact pathogen and antimicrobial susceptibilities, the acceptable antibiotics was used. Etiology The etiology of spondylodiscitis can be infectious or non-infectious. Infectious spondylodiscitis is caused by the invasion of microorganisms into the disc space and the vertebral endplates, usually through hematogenous spread from a distant focus of infection, such as the skin, urinary tract, respiratory tract or endocardium. The most common pathogens are Staphylococcus aureus, followed by Escherichia coli, Streptococcus species and Pseudomonas aeruginosa. Non-infectious spondylodiscitis is associated with inflammatory disorders, such as ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis and reactive arthritis, or with degenerative processes, such as disc herniation, osteoporosis and trauma [ 13 , 26 , 29 ]. Conservative treatment and surgical intervention For the treatment of pathogen-associated spondylodiscitis, conservative treatment with empiric antibiotics has served as the first-line therapy in the recent consensus for at least six weeks of intravenous form of antibiotics [ 13 ]. Unfortunately, for the increasing complexity of the pathogens due to exorbitant medication prescription, pathogen-spectrum guided antibiotic therapy emerged to be the most crucial. Targeted antibiotics treatment with corresponding pathogen detected had launched as the first priority, but for the perplexing method of surgical or CT-guided biopsy, because of the concealed pathogen clustering site, it had shown to be less successful for approximately 49–83% of all cases around the world [ 12 ]. As for the antibiotics-recessed patients or the cases with newly neurological deficit, sepsis, presence of intraspinal or epidural abscess, or instability for segmental kyphosis > 15 degree, vertebral body collapse > 50%, and translation > 5mm, surgical intervention had reached and laminectomy with debridement were done in the great proportion of the cases of which the nerve roots and thecal sac were decompressed, followed by debridement of the infectious or inflammatory tissue in the paraspinal or epidural space, and last but not least, culture was collected from them [ 13 ]. For the spinal instability mentioned above, transpedicle screw fixation with titanium screws and rods were performed, but fusion with the cage was not indicated for the sake of preventing further prosthesis-related infection, and otherwise, drainage tube was placed for the duration of the antibiotics treatment, because it might constitute not only a drainage system for intraoperative hemorrhage but also a clinical observation for the disease processing [ 14 ]. Variables Statistical Analysis In our study, the patient’s characteristics and the outcomes between the two groups of mortality and survival were analyzed utilizing the Chi-Square test for categorical variables and the Wilcoxon’s rank sum test for continuous variables. Univariate and multivariate logistic regression analysis were performed for analyzing the concurrent risk factors that might affect the in-hospital mortality. P-value equal or less than 0.05 was considered statistically significant. Results Patient characteristics In our study, we had enrolled 340 patients with the diagnosis of spinal infection, including spondylodiscitis, vertebral osteomyelitis, and epidural abscess, and the characteristics were shown in Table 1 which revealed the overall 66% of the patients were men with the average age (mean ± SD) and BMI (mean ± SD) being 62.8 ± 15.3 and 25.8 ± 13.1, respectively. Several comorbidities were concerned for the obscure potential attributing to the in-hospital mortality as there were 165(49%) cases with hypertension, 112(33%) cases with diabetes, 47(14%) cases with dyslipidemia, 32(9%) with coronary artery disease, and 60(18%) cases with chronic renal disease. Among all the patients, 102(30%) cases had received the surgery, no matter if internal fixation or discectomy alone was done. Table 1 Baseline characteristics for the 340 patients during 2014/1/1-2021/12/31. Total With 1 year mortality Without 1 year mortality Variable n = 340 (%) n = 40 (%) n = 300 (%) p-value Age (mean ± SD) 62.8 ± 15.3 66.2 ± 15.4 62.3 ± 15.2 0.132 Male 223 (66) 26 (65) 197 (66) 0.934 BMI 25.8 ± 13.1 30.4 ± 36.2 25.2 ± 4.8 0.019 Baseline comorbidities Hypertension 165 (49) 27 (68) 138 (46) 0.011 Diabetes 112 (33) 15 (38) 97 (32) 0.514 Hyperlipidemia 47 (14) 4 (10) 43 (14) 0.456 Coronary artery disease 32 (9) 5 (13) 27 (9) 0.476 Renal failure 60 (18) 14 (35) 46 (15) 0.002 Surgical intervention 102 (30) 5 (13) 97 (32) 0.010 Lab data White blood cell 11.7 ± 6.2 10.9 ± 6.4 11.8 ± 6.2 0.356 Hemoglobin 11.6 ± 2.2 10.4 ± 2.6 11.7 ± 2.1 < 0.001 HCT 34.9 ± 6.3 31.6 ± 7.6 35.3 ± 6.0 < 0.001 Platelet 276.5 ± 134.1 268.4 ± 164.8 277.6 ± 129.7 0.686 Lym 13.9 ± 9.5 12.2 ± 8.3 14.1 ± 9.7 0.239 NLR 12.1 ± 15.9 12.2 ± 15.7 12.0 ± 15.9 0.940 Creatinine 1.7 ± 1.8 2.3 ± 2.0 1.6 ± 1.8 0.024 eGFR 68.8 ± 35.4 56.8 ± 42.5 70.4 ± 34.1 0.022 GPT 29.8 ± 29.4 22.5 ± 18.4 30.8 ± 30.5 0.092 GOT 30.8 ± 23.7 32.8 ± 21.6 30.6 ± 24.0 0.587 T-bil 0.8 ± 0.9 0.9 ± 0.9 0.7 ± 0.9 0.448 Lactate 2.8 ± 7.4 4.7 ± 12.7 2.5 ± 6.1 0.239 Albumin 3.0 ± 0.7 2.5 ± 0.8 3.0 ± 0.6 < 0.001 PCT 2.1 ± 5.9 0.5 ± 0.6 2.5 ± 6.5 0.418 CRP 10.7 ± 9.8 13.6 ± 11.2 10.4 ± 9.6 0.058 ESR 65.0 ± 31.8 67.8 ± 26.7 64.7 ± 32.3 0.657 Bacterial 320 (94) 38 (95) 282 (94) 0.801 TB 9 (5) 2 (13) 7 (4) 0.181 FUNG 9 (5) 2 (13) 7 (4) 0.206 LOS 36.2 ± 21.8 43.5 ± 28.2 35.2 ± 20.6 0.023 Table 2. Logistic regression analysis for 340 Patients. Variable OR (95% CI) p-value Adjusted OR (95% CI) p-value Age 1.02 (0.99–1.04) 0.133 Male 0.97 (0.49–1.94) 0.934 BMI 1.01 (0.99–1.04) 0.149 Baseline comorbidities Hypertension 2.44 (1.21–4.91) 0.013 Diabetes 1.26 (0.63–2.49) 0.514 Hyperlipidemia 0.66 (0.23–1.96) 0.459 Coronary artery disease 1.44 (0.52–3.99) 0.479 Renal failure 2.97 (1.45–6.12) 0.003 2.95 (1.39–6.27) 0.005 Surgical intervention With Ref Without 3.35 (1.27–8.80) 0.014 2.99 (1.11–8.07) 0.030 Lab data White blood cell 0.97 (0.92–1.03) 0.132 Hemoglobin 0.77 (0.67–0.90) 0.001 Platelet 1.00 (0.99-1.00) 0.685 NLR 1.00 (0.98–1.02) 0.939 Creatinine 1.17 (1.01–1.34) 0.032 GPT 0.98 (0.96-1.00) 0.089 T-bil 1.12 (0.83–1.52) 0.454 CRP 1.03 (0.99–1.07) 0.061 1.03 (1.00-1.07) 0.078 Bacteria 1.00 (0.99–1.02) 0.656 Hosmer-Lemeshow test χ 2 = 8.093 0.424 Laboratory data with mortality We aimed to launch with a novel prediction model for the in-hospital mortality while the laboratory data were reviewed as the first visit to our outpatient department or emergency room due to the infection, whether clinical symptoms showing the most common discomforts of back pain or other infectious sign such as fatigue, general malaise, or hemiparesis. The average of white blood cells for all the patients was 11.7 ± 6.2, and there was no statistically significant difference between the mortality group and the survival one (10.9 ± 6.4 vs. 11.8 ± 6.2, p-value = 0.356). The average of other essential laboratory data for CRP, Hemoglobin, eGFR, Albumin being 10.7 ± 9.8, 11.6 ± 2.2, 68.8 ± 35.4, 3.0 ± 0.7 with mortality vs. survival showing 13.6 ± 11.2 vs. 10.4 ± 9.6 (p-value = 0.058), 10.4 ± 2.6 vs. 11.7 ± 2.1 (p-value < 0.001), 56.8 ± 42.5 vs. 70.4 ± 34.1 (p-value = 0.022), and 2.5 ± 0.8 vs. 3.0 ± 0.6 (p-value < 0.001), respectively. Microbiological findings Currently, there are three major categories of infectious pathogens are recognized: bacteria, which often cause pyogenic infection; fungi and Mycobacterium tuberculosis, which may lead to granulomatous infection; and in rare cases, parasites [ 6 , 7 , 8 ]. In this study, all 340 enrolled patients were included. Most of them had bacterial cultures performed. Among these, 282 patients survived after one year with consistent follow-up in the outpatient department, but there was no statistically significant difference in mortality rates between survivors and non-survivors. While a small number of patients had cultured with tuberculosis bacteria or fungus, it should still be a crucial concern since most of the patients had died within one year of diagnosis. Logistic regression analysis for overall mortality The utilization of logistic regression for in-hospital mortality related to the predictors was mentioned in Table 2. Prevalence of higher mortality was significantly associated with patients possessing the comorbidities of hypertension [OR: 2.44 (1.21–4.91), p-value = 0.013], renal function [OR: 2.97 (1.45–6.12), p-value = 0.003], without surgical intervention [OR:3.35 (1.27–8.80), p-value = 0.014], hemoglobin [OR: 0.77 (0.67–0.90), p-value = 0.001], and CRP [OR: 1.03 (0.99–1.07), p-value = 0.061] for univariable logistic regression. As for the multivariate logistic regression, poor renal function [OR: 2.95 (1.39–6.27), p-value = 0.005] and no surgical intervention [OR: 2.99 (1.11–8.07), p-value = 0.030] tend to increase the mortality rate in an apparent extent. It is still notable that CRP in the multivariate logistic regression model with an odds ratio of 1.03 (1.00-1.07) with p-value = 0.078, which might serve as a potential factor for the in-hospital mortality predictor. Overall, the length of stay (LOS) with an average of 36.2(14–58) days indicated a conventional treatment of antibiotics for two to six weeks at least for the intravenous antibiotics injection, no matter the exact culture result being obtained. The median LOS was significantly shorter in the survival group (35.2 ± 20.6) within one year than the mortality one (43.5 ± 28.2), p-value = 0.023. It should be a concern for the patients passed away within one year after the initial diagnosis that there might be concomitance of other comorbidities during the first-time admission with spinal infection. Discussion Spondylodiscitis is a rare but serious condition that affects the spine. It is characterized by inflammation and infection of the intervertebral disc and the adjacent vertebral bodies. The most common cause of spondylodiscitis is a bacterial infection, usually by staphylococci, that spreads from another site of the body, such as the heart or the skin. Spondylodiscitis can lead to complications such as osteomyelitis, spinal instability, neurological deficits, and sepsis. The main symptom of spondylodiscitis is back pain, which may be accompanied by fever, malaise, and weight loss. It is our acknowledgement that predictive factors for the mortality of spinal infection were not fully discussed in the recent studies, so we are aiming to propose an innovative prediction model for the severity that might cause in-hospital mortality. Our major findings are that conservative treatment only, chronic kidney disease, and CRP might be some of the independent predictors for the mortality of spinal infection. Our data demonstrates a decrease in the mortality rate of the patients whom the surgery was implemented, which is compatible with the result of previous data that Stüer et al. had reported [ 15 ] and the incidence increase or neurological function deterioration for the delayed surgical intervention proposed by Alton et al. [ 16 ] with a significant amelioration of motor score from electronic medical record for the patient received surgery in an average of 24.4 hours after the imaging diagnosis. For the study proposed by Waheed et al. [ 14 ], broad-spectrum of antibiotics were given if there is no surgical indication, but shortly as the criteria for operation was sufficient, operation was performed and antibiotics prescription would be in accordance to the culture collected intraoperatively, which is the same strategy we followed in our institution [ 15 ]. Although the global consensus of antibiotics treatment duration of at least for six weeks advocated by the Infectious Diseases Society of America (IDSA) for most of the patients with non-specific spondylodiscitis, there is still a debate on the time of transforming intravenous antibiotics to oral form. Bernard et al had come up with a shorter period of intravenous medication treatment for a median of two weeks (interquartile range of 7–27 days), but IDSA still announced of administration of well oral bioavailability agents as possible oral alternatives such as Quinolones, clindamycin, and cotrimoxazole being suitable for this purpose, which should handle the ability of covering the most common pathogens (S. aureus, streptococci, and E. coli). Also, OVIVA (oral versus intravenous antibiotics for bone and joint infections) is currently studying the possibility of other suitable agents for the substitute [ 1 , 15 , 17 ]. Furthermore, Gouliouris et al. had recommended the accurate dose and the category of antibiotics toward specific pathogens with no discontinuation for the sake of refraining from any possibility of disease flares up or recurrence [ 17 , 18 ]. Grados et al. had also reported a noticing higher recurrence rate for the patients receiving antibiotics treatment less than eight weeks compared to the longer group that is treated at least for 12 weeks [ 19 ]. As for the surgical intervention, which is mainly focusing on eliminating the focus of infection, spinal stability restoration, and pain control, there is an increase for the in-hospital mortality rate being noted for those who had not received the operation, though approximately only 12% of patients had died within one year since diagnosis. Nevertheless, even with the low mortality rate of the disease, once the surgical indication was encountered, surgery was still highly recommended for those who had deteriorating neurological deficit, ongoing sepsis, presence of intraspinal or epidural abscess, or instability for segmental kyphosis. Akiyama T et al had come up with another opinion which is not statistically significant between the infection and mortality, but they had suggested whether the operation could have some benefits should be performed by randomized control study which is nearly impossible in reality [ 20 , 21 , 22 ]. Kehrer et al. proposed a study with the comparison of short-term (20%) and long-term (11%) mortality in which short-term mortality was defined as expiring within one year after the initial diagnosis that is compatible with our current study [ 23 ]. Pola et al. had presented a treatment algorithm of the spinal infection according to the retrospective study they were conducting in which imaging findings were taken into consideration [ 24 ]. Otherwise, CT-guided drainage placement with infectious site biopsy had been documented at an average successful rate around 87.5%, which might be an alternative treatment for the patient that is at high risk of receiving the operation such as elderly, previous stroke, arrhythmia, etc [ 25 ]. In accordance with the innovation of the surgeries, different approach and strategy had also been discussed nowaday, which Nasto et al. provided a better intention of minimally invasive transpedicular screw stabilization with debridement, resulting in a faster recovery time and functional outcome, and moreover, Si et al. had performed the minimally invasive procedures with retroperitoneal transpsoas approach (XLIF) that seemed to be superior than conventional approach with better infectious site removal, lumbar lordosis correction, and posterior instrumentation [ 27 , 28 ]. Interestingly, length of stay in the hospital was found to be shorter for the survival group, which is around 5 weeks (35.2 ± 20.6) compared to the mortality one (43.5 ± 28.2). Appealing as further subgroup analysis is, which might contain the greater understanding into the variables that could affect the result such as specific culture, surgery, antibiotics usage, etc., it is not our main topic for this secession, for we are concentrating on the potentially predictive factors for the outcome with spinal infection, and for the sake of dealing with the matter, surgical intervention constitutes a predictor toward the one year in-hospital mortality. Besides mortality, Yashiomoto et al. revealed that the amelioration of neurological symptoms would be mentioned within ten months of the regular follow-up in 72% of all patients [ 26 ]. Based on the conclusions of their study, our future research could investigate the functional outcomes and the recurrence of spinal infection. Limitation Our study still has limitations, including its retrospective design, loss to follow-up in some patients, and a relatively small sample size due to being conducted at a single institution. Further research should be conducted, such as subgroups analysis for the variables affecting the length of stay, different surgical approaches, and ages. As for the innovation of surgical intervention, it comprises a fascinating topic which could be comparing the difference among them with no limit to mortality but also recurrence, functional outcome amelioration, and spinal stability. Conclusion For patients with spontaneous spinal infection, we identified several risk factors. This useful information may help physicians pay particular attention to the presence of these risk factors when managing patients, hereby ensuring more careful monitoring and care. In this study, we developed a novel predictive model for in-hospital mortality in spinal infection patients, identifying chronic renal disease, spinal surgery, and CRP levels as significant prognostic factors with strong predictive value. Although there are still plenty of topics we could conduct, we are glad to advocate the importance of the comorbidities or clinical strategies mentioned above. Declarations Acknowledgements: Not applicable Disclosure-Conflict of Interest All authors have declared that: no financial support has been received from any institution. There are no other relationships or activities that could appear to have influenced the submitted work Funding statement: Not applicable Informed consent statement: Ethics approval and consent to participate were approved by the committee of our institution. 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PMID: 21181482; PMCID: PMC3065596 Nasto LA, Colangelo D, Mazzotta V, Di Meco E, Neri V, Nasto RA, Fantoni M, Pola E (2014) Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis. Spine J. 14(7):1139-46. doi: 10.1016/j.spinee.2013.07.479. Epub 2013 Oct 16. PMID: 24139231 Si M, Yang ZP, Li ZF, Yang Q, Li JM (2013) Anterior versus posterior fixation for the treatment of lumbar pyogenic vertebral osteomyelitis. Orthopedics. 36(6):831-6. 10.3928/01477447-20130523-33 . PMID: 23746024 Chang WS, Ho MW, Lin PC, Ho CM, Chou CH, Lu MC, Chen YJ, Chen HT, Wang JH, Chi CY (2018) Clinical characteristics, treatments, and outcomes of hematogenous pyogenic vertebral osteomyelitis, 12-year experience from a tertiary hospital in central Taiwan. J Microbiol Immunol Infect 51(2):235–242 Epub 2017 Aug 19. PMID: 28847713 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8116934","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596459101,"identity":"36f812b4-e642-4a83-ac73-6a200a1ddbe4","order_by":0,"name":"Jiun-Huan Liau","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiun-Huan","middleName":"","lastName":"Liau","suffix":""},{"id":596459102,"identity":"07ee664e-d69d-4862-82df-a37323f240ca","order_by":1,"name":"Yu-Lun Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYPACtgQ+ZsbGBwkGEnIg7oEHeBVDtbCxMx82+FBgYwzWkkBYC0MCGz9bmuSMD2mJDWAuHh3y85uPSXzcwZfHxsxjIM1jcDh9ftjhh0Bb7OR0G7BrMTgGNHzmGbZikBZjoJbcjbfTDIBako3NDuDQwsZjbMzbxpbYBtSSDNYyOwGk5UDiNhxa5Nv4Pxv/hWo5DHKY4ez0D3i1MBzjYXzMCNbCltg4wyAtQV46B78tBsfSDB/2grUwH2b4YGBjuEE6p+BAggFuv8g3H35w4GfbscR+/oPtPxL+SMjLz07f/OFDhZ0cLi0w5yHZC1ZpgFc5CNQg2dtAUPUoGAWjYBSMMAAAqhRgCxqpLUMAAAAASUVORK5CYII=","orcid":"","institution":"China Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yu-Lun","middleName":"","lastName":"Wu","suffix":""},{"id":596459103,"identity":"c9d548c9-b08b-4874-9f99-c601f3a64c7c","order_by":2,"name":"Jin-Shuen Chen","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jin-Shuen","middleName":"","lastName":"Chen","suffix":""},{"id":596459104,"identity":"5874ee61-453c-49fb-b395-363458b58d91","order_by":3,"name":"Chun-Hao Yin","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chun-Hao","middleName":"","lastName":"Yin","suffix":""}],"badges":[],"createdAt":"2025-11-14 16:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8116934/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8116934/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105846287,"identity":"f82b321c-2a1d-4962-b3af-5d6bd08c4f0b","added_by":"auto","created_at":"2026-03-31 17:55:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":505649,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8116934/v1/b8648a6c-3216-40ec-912a-36c429e3a294.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, risk factors of mortality, and clinical outcomes in patients with spontaneous spinal infection","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpinal infection had been an emerging issue worldwide due to its potential of contributing to life-threatening disease, and though rare as it was in the past, spondylodiscitis still encountering with an incidence of 0.4-2 cases per 100,000 patients each year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] with a tendency of increasing due to the evolution of diagnostic equipment and treatment method recently, having a preponderance of patients with debilitating disease such as diabetes mellitus, chronic renal impairment, obesity, previous spinal surgery, and elderly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] with an overall mortality rate lying between 4.5% and 11% according to the current study [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although several predisposing factors had been issued as mentioned previously, we aim to focus on the variables which could facilitate the mortality, not being confined to spinal surgery which had long term been notorious for its crucial roles connecting with spinal infection (5), and that is, other factors would be treated equally as still possessing different contents of resulting in spondylodiscitis. Moreover, whether the patients present with obvious clinical symptoms such as pain of lower back or legs or not, which had been the most common symptoms among the spinal infection victims, there are still candidates for spondylodiscitis followed by some of the ordinary infectious signs such as fever, which had been noted approximately half of whom had diagnosed while admission with ambiguous infection source initially, and paresis, about one-third of the patients worldwide reported [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Due to the presentation with variability, early detection of the disease still meant to be a challenge and thus, early intervention should be taken into consideration.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eData source\u003c/p\u003e \u003cp\u003eThis is a retrospective analysis in which 340 patients were enrolled to our study from January 1st, 2014 to December 31st, 2021 with the abstract of discharge note being reviewed since the administrative claim data from admission to the precise diagnosis while discharge. Several laboratory and clinical data was collected involving: age, sex, BMI, comorbidities at the time of admission, surgical intervention during hospitalization, ICD-10 revision code, length of stay, and in-hospital mortality. Moreover, infection related to spinal surgery was excluded from our study, for the sake of focusing on the spontaneous spondylodiscitis as which the clinical (fever, back pain, claudication, paralysis with lower limbs, presenting with wheelchair while arriving), history(previous blood stream or urinary infection, comorbidities such as chronic renal disease, cardiovascular events, hypertension, diabetes mellitus, obesity, etc.), laboratory(white blood cell, C-reactive protein, Erythrocyte sedimentation rate), and the image study (Computed tomography or Magnetic resonance imaging) were compatible for the diagnosis defined. As the surgical intervention (laminectomy, discectomy, and debridement) being one of the independent variables against mortality, confirmation of the exact culture data from the infectious site was not capable for all the patients, for among the surgeons from our faculty, indication or criteria for operation differs to each other but some of the absolute surgical indication was met as epidural abscess, progressed neurological deficit, spinal instability or deformity, or radiologic and clinical deterioration after long term antibiotics treatment, so empiric antibiotics was prescribed for the patient without surgery or CT-guided biopsy, and for those who had received the operation with the exact pathogen and antimicrobial susceptibilities, the acceptable antibiotics was used.\u003c/p\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003cp\u003eThe etiology of spondylodiscitis can be infectious or non-infectious. Infectious spondylodiscitis is caused by the invasion of microorganisms into the disc space and the vertebral endplates, usually through hematogenous spread from a distant focus of infection, such as the skin, urinary tract, respiratory tract or endocardium. The most common pathogens are Staphylococcus aureus, followed by Escherichia coli, Streptococcus species and Pseudomonas aeruginosa. Non-infectious spondylodiscitis is associated with inflammatory disorders, such as ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis and reactive arthritis, or with degenerative processes, such as disc herniation, osteoporosis and trauma [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConservative treatment and surgical intervention\u003c/p\u003e \u003cp\u003eFor the treatment of pathogen-associated spondylodiscitis, conservative treatment with empiric antibiotics has served as the first-line therapy in the recent consensus for at least six weeks of intravenous form of antibiotics [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Unfortunately, for the increasing complexity of the pathogens due to exorbitant medication prescription, pathogen-spectrum guided antibiotic therapy emerged to be the most crucial. Targeted antibiotics treatment with corresponding pathogen detected had launched as the first priority, but for the perplexing method of surgical or CT-guided biopsy, because of the concealed pathogen clustering site, it had shown to be less successful for approximately 49\u0026ndash;83% of all cases around the world [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As for the antibiotics-recessed patients or the cases with newly neurological deficit, sepsis, presence of intraspinal or epidural abscess, or instability for segmental kyphosis\u0026thinsp;\u0026gt;\u0026thinsp;15 degree, vertebral body collapse\u0026thinsp;\u0026gt;\u0026thinsp;50%, and translation\u0026thinsp;\u0026gt;\u0026thinsp;5mm, surgical intervention had reached and laminectomy with debridement were done in the great proportion of the cases of which the nerve roots and thecal sac were decompressed, followed by debridement of the infectious or inflammatory tissue in the paraspinal or epidural space, and last but not least, culture was collected from them [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For the spinal instability mentioned above, transpedicle screw fixation with titanium screws and rods were performed, but fusion with the cage was not indicated for the sake of preventing further prosthesis-related infection, and otherwise, drainage tube was placed for the duration of the antibiotics treatment, because it might constitute not only a drainage system for intraoperative hemorrhage but also a clinical observation for the disease processing [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVariables\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eIn our study, the patient\u0026rsquo;s characteristics and the outcomes between the two groups of mortality and survival were analyzed utilizing the Chi-Square test for categorical variables and the Wilcoxon\u0026rsquo;s rank sum test for continuous variables. Univariate and multivariate logistic regression analysis were performed for analyzing the concurrent risk factors that might affect the in-hospital mortality. P-value equal or less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ePatient characteristics\u003c/p\u003e\n\u003cp\u003eIn our study, we had enrolled 340 patients with the diagnosis of spinal infection, including spondylodiscitis, vertebral osteomyelitis, and epidural abscess, and the characteristics were shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e which revealed the overall 66% of the patients were men with the average age (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) and BMI (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) being 62.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3 and 25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1, respectively. Several comorbidities were concerned for the obscure potential attributing to the in-hospital mortality as there were 165(49%) cases with hypertension, 112(33%) cases with diabetes, 47(14%) cases with dyslipidemia, 32(9%) with coronary artery disease, and 60(18%) cases with chronic renal disease. Among all the patients, 102(30%) cases had received the surgery, no matter if internal fixation or discectomy alone was done.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics for the 340 patients during 2014/1/1-2021/12/31.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWith 1 year mortality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWithout 1 year mortality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;340 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;40 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;300 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223 (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e197 (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLab data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite blood cell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e276.5\u0026thinsp;\u0026plusmn;\u0026thinsp;134.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e268.4\u0026thinsp;\u0026plusmn;\u0026thinsp;164.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e277.6\u0026thinsp;\u0026plusmn;\u0026thinsp;129.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLym\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNLR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCreatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeGFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.8\u0026thinsp;\u0026plusmn;\u0026thinsp;35.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.8\u0026thinsp;\u0026plusmn;\u0026thinsp;42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.8\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.6\u0026thinsp;\u0026plusmn;\u0026thinsp;24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT-bil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLactate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.0\u0026thinsp;\u0026plusmn;\u0026thinsp;31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBacterial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e320 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e282 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFUNG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eTable 2. Logistic regression analysis for 340 Patients.\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.99\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97 (0.49\u0026ndash;1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.99\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.44 (1.21\u0026ndash;4.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26 (0.63\u0026ndash;2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66 (0.23\u0026ndash;1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.52\u0026ndash;3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.97 (1.45\u0026ndash;6.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.95 (1.39\u0026ndash;6.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.35 (1.27\u0026ndash;8.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.99 (1.11\u0026ndash;8.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLab data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite blood cell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97 (0.92\u0026ndash;1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77 (0.67\u0026ndash;0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.99-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNLR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.98\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCreatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17 (1.01\u0026ndash;1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98 (0.96-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT-bil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12 (0.83\u0026ndash;1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.99\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (1.00-1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBacteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.99\u0026ndash;1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHosmer-Lemeshow test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;8.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eLaboratory data with mortality\u003c/p\u003e\n\u003cp\u003eWe aimed to launch with a novel prediction model for the in-hospital mortality while the laboratory data were reviewed as the first visit to our outpatient department or emergency room due to the infection, whether clinical symptoms showing the most common discomforts of back pain or other infectious sign such as fatigue, general malaise, or hemiparesis. The average of white blood cells for all the patients was 11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2, and there was no statistically significant difference between the mortality group and the survival one (10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 vs. 11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2, p-value\u0026thinsp;=\u0026thinsp;0.356). The average of other essential laboratory data for CRP, Hemoglobin, eGFR, Albumin being 10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8, 11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2, 68.8\u0026thinsp;\u0026plusmn;\u0026thinsp;35.4, 3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 with mortality vs. survival showing 13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2 vs. 10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6 (p-value\u0026thinsp;=\u0026thinsp;0.058), 10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 vs. 11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 56.8\u0026thinsp;\u0026plusmn;\u0026thinsp;42.5 vs. 70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;34.1 (p-value\u0026thinsp;=\u0026thinsp;0.022), and 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 vs. 3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively.\u003c/p\u003e\n\u003cp\u003eMicrobiological findings\u003c/p\u003e\n\u003cp\u003eCurrently, there are three major categories of infectious pathogens are recognized: bacteria, which often cause pyogenic infection; fungi and Mycobacterium tuberculosis, which may lead to granulomatous infection; and in rare cases, parasites [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this study, all 340 enrolled patients were included. Most of them had bacterial cultures performed. Among these, 282 patients survived after one year with consistent follow-up in the outpatient department, but there was no statistically significant difference in mortality rates between survivors and non-survivors. While a small number of patients had cultured with tuberculosis bacteria or fungus, it should still be a crucial concern since most of the patients had died within one year of diagnosis.\u003c/p\u003e\n\u003cp\u003eLogistic regression analysis for overall mortality\u003c/p\u003e\n\u003cp\u003eThe utilization of logistic regression for in-hospital mortality related to the predictors was mentioned in Table\u0026nbsp;2. Prevalence of higher mortality was significantly associated with patients possessing the comorbidities of hypertension [OR: 2.44 (1.21\u0026ndash;4.91), p-value\u0026thinsp;=\u0026thinsp;0.013], renal function [OR: 2.97 (1.45\u0026ndash;6.12), p-value\u0026thinsp;=\u0026thinsp;0.003], without surgical intervention [OR:3.35 (1.27\u0026ndash;8.80), p-value\u0026thinsp;=\u0026thinsp;0.014], hemoglobin [OR: 0.77 (0.67\u0026ndash;0.90), p-value\u0026thinsp;=\u0026thinsp;0.001], and CRP [OR: 1.03 (0.99\u0026ndash;1.07), p-value\u0026thinsp;=\u0026thinsp;0.061] for univariable logistic regression. As for the multivariate logistic regression, poor renal function [OR: 2.95 (1.39\u0026ndash;6.27), p-value\u0026thinsp;=\u0026thinsp;0.005] and no surgical intervention [OR: 2.99 (1.11\u0026ndash;8.07), p-value\u0026thinsp;=\u0026thinsp;0.030] tend to increase the mortality rate in an apparent extent. It is still notable that CRP in the multivariate logistic regression model with an odds ratio of 1.03 (1.00-1.07) with p-value\u0026thinsp;=\u0026thinsp;0.078, which might serve as a potential factor for the in-hospital mortality predictor.\u003c/p\u003e\n\u003cp\u003eOverall, the length of stay (LOS) with an average of 36.2(14\u0026ndash;58) days indicated a conventional treatment of antibiotics for two to six weeks at least for the intravenous antibiotics injection, no matter the exact culture result being obtained. The median LOS was significantly shorter in the survival group (35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6) within one year than the mortality one (43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;28.2), p-value\u0026thinsp;=\u0026thinsp;0.023. It should be a concern for the patients passed away within one year after the initial diagnosis that there might be concomitance of other comorbidities during the first-time admission with spinal infection.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSpondylodiscitis is a rare but serious condition that affects the spine. It is characterized by inflammation and infection of the intervertebral disc and the adjacent vertebral bodies. The most common cause of spondylodiscitis is a bacterial infection, usually by staphylococci, that spreads from another site of the body, such as the heart or the skin. Spondylodiscitis can lead to complications such as osteomyelitis, spinal instability, neurological deficits, and sepsis. The main symptom of spondylodiscitis is back pain, which may be accompanied by fever, malaise, and weight loss. It is our acknowledgement that predictive factors for the mortality of spinal infection were not fully discussed in the recent studies, so we are aiming to propose an innovative prediction model for the severity that might cause in-hospital mortality. Our major findings are that conservative treatment only, chronic kidney disease, and CRP might be some of the independent predictors for the mortality of spinal infection.\u003c/p\u003e \u003cp\u003eOur data demonstrates a decrease in the mortality rate of the patients whom the surgery was implemented, which is compatible with the result of previous data that St\u0026uuml;er et al. had reported [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and the incidence increase or neurological function deterioration for the delayed surgical intervention proposed by Alton et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] with a significant amelioration of motor score from electronic medical record for the patient received surgery in an average of 24.4 hours after the imaging diagnosis. For the study proposed by Waheed et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], broad-spectrum of antibiotics were given if there is no surgical indication, but shortly as the criteria for operation was sufficient, operation was performed and antibiotics prescription would be in accordance to the culture collected intraoperatively, which is the same strategy we followed in our institution [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although the global consensus of antibiotics treatment duration of at least for six weeks advocated by the Infectious Diseases Society of America (IDSA) for most of the patients with non-specific spondylodiscitis, there is still a debate on the time of transforming intravenous antibiotics to oral form. Bernard et al had come up with a shorter period of intravenous medication treatment for a median of two weeks (interquartile range of 7\u0026ndash;27 days), but IDSA still announced of administration of well oral bioavailability agents as possible oral alternatives such as Quinolones, clindamycin, and cotrimoxazole being suitable for this purpose, which should handle the ability of covering the most common pathogens (S. aureus, streptococci, and E. coli). Also, OVIVA (oral versus intravenous antibiotics for bone and joint infections) is currently studying the possibility of other suitable agents for the substitute [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, Gouliouris et al. had recommended the accurate dose and the category of antibiotics toward specific pathogens with no discontinuation for the sake of refraining from any possibility of disease flares up or recurrence [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Grados et al. had also reported a noticing higher recurrence rate for the patients receiving antibiotics treatment less than eight weeks compared to the longer group that is treated at least for 12 weeks [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs for the surgical intervention, which is mainly focusing on eliminating the focus of infection, spinal stability restoration, and pain control, there is an increase for the in-hospital mortality rate being noted for those who had not received the operation, though approximately only 12% of patients had died within one year since diagnosis. Nevertheless, even with the low mortality rate of the disease, once the surgical indication was encountered, surgery was still highly recommended for those who had deteriorating neurological deficit, ongoing sepsis, presence of intraspinal or epidural abscess, or instability for segmental kyphosis. Akiyama T et al had come up with another opinion which is not statistically significant between the infection and mortality, but they had suggested whether the operation could have some benefits should be performed by randomized control study which is nearly impossible in reality [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Kehrer et al. proposed a study with the comparison of short-term (20%) and long-term (11%) mortality in which short-term mortality was defined as expiring within one year after the initial diagnosis that is compatible with our current study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Pola et al. had presented a treatment algorithm of the spinal infection according to the retrospective study they were conducting in which imaging findings were taken into consideration [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Otherwise, CT-guided drainage placement with infectious site biopsy had been documented at an average successful rate around 87.5%, which might be an alternative treatment for the patient that is at high risk of receiving the operation such as elderly, previous stroke, arrhythmia, etc [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In accordance with the innovation of the surgeries, different approach and strategy had also been discussed nowaday, which Nasto et al. provided a better intention of minimally invasive transpedicular screw stabilization with debridement, resulting in a faster recovery time and functional outcome, and moreover, Si et al. had performed the minimally invasive procedures with retroperitoneal transpsoas approach (XLIF) that seemed to be superior than conventional approach with better infectious site removal, lumbar lordosis correction, and posterior instrumentation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, length of stay in the hospital was found to be shorter for the survival group, which is around 5 weeks (35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6) compared to the mortality one (43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;28.2). Appealing as further subgroup analysis is, which might contain the greater understanding into the variables that could affect the result such as specific culture, surgery, antibiotics usage, etc., it is not our main topic for this secession, for we are concentrating on the potentially predictive factors for the outcome with spinal infection, and for the sake of dealing with the matter, surgical intervention constitutes a predictor toward the one year in-hospital mortality. Besides mortality, Yashiomoto et al. revealed that the amelioration of neurological symptoms would be mentioned within ten months of the regular follow-up in 72% of all patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Based on the conclusions of their study, our future research could investigate the functional outcomes and the recurrence of spinal infection.\u003c/p\u003e \u003cp\u003eLimitation\u003c/p\u003e \u003cp\u003e Our study still has limitations, including its retrospective design, loss to follow-up in some patients, and a relatively small sample size due to being conducted at a single institution. Further research should be conducted, such as subgroups analysis for the variables affecting the length of stay, different surgical approaches, and ages. As for the innovation of surgical intervention, it comprises a fascinating topic which could be comparing the difference among them with no limit to mortality but also recurrence, functional outcome amelioration, and spinal stability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor patients with spontaneous spinal infection, we identified several risk factors. This useful information may help physicians pay particular attention to the presence of these risk factors when managing patients, hereby ensuring more careful monitoring and care. In this study, we developed a novel predictive model for in-hospital mortality in spinal infection patients, identifying chronic renal disease, spinal surgery, and CRP levels as significant prognostic factors with strong predictive value. Although there are still plenty of topics we could conduct, we are glad to advocate the importance of the comorbidities or clinical strategies mentioned above.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eDisclosure-Conflict of Interest\u003c/p\u003e\n\u003cp\u003eAll authors have declared that: no financial support has been received from any institution. There are no other relationships or activities that could appear to have influenced the submitted work\u003c/p\u003e\n\u003cp\u003eFunding statement:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eInformed consent statement:\u003c/p\u003e\n\u003cp\u003eEthics approval and\u0026nbsp;consent to participate were approved by the committee of our institution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe need for consent of participants was waived by our IRB committee: Kaohsiung Veteran General Hospital IRB: T-29143\u003c/p\u003e\n\u003cp\u003eOur study had abided by the Helsinki Declaration\u003c/p\u003e\n\u003cp\u003eData availability statement:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKehrer M, Pedersen C, Jensen TG, Lassen AT (2014) Increasing incidence of pyogenic spondylodiscitis: a 14-year population based study. 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PMID: 28847713\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8116934/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8116934/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Purpose: Identifying the risk factors for spontaneous spinal infection is the main purpose.\nMethods: A retrospective chart review revealed patients with spinal infection following for one year, excluding the patients who had received spinal surgery before the diagnosis. There were 340 patients enrolled to the study with spontaneous spondylodiscitis during the period between January, 2014 and December, 2021, which had received full clinical assessment, laboratory test, radiological study and clinical management. MRI was performed for the initial diagnosis and up to 12 months of following.\nResults: Among the 340 patients with an average age of 63 years, 40 patients expired due to the infection within 12 months of diagnosis, of which 5 patients received surgical intervention compared to 97 patients for the survival group. Univariable logistic regression analysis demonstrated hypertension [OR: 2.44 (1.21-4.91), p = 0.013], renal impairment [OR: 2.97 (1.45-6.12), p = 0.003], without surgical intervention [OR: 3.35 (1.27-8.00), p = 0.014], hemoglobin [OR: 0.77 (0.67-0.90), p = 0.001], and CRP [OR: 1.03 (0.99-1.07), p = 0.061]. While multivariable logistic regression analysis demonstrated renal impairment [OR: 2.95 (1.39-6.27), p = 0.005], without surgical intervention [OR: 2.99 (1.11-8.07), p = 0.030] as the independent factors.\nConclusions: Impaired renal function and surgical intervention were identified as predictors of one-year mortality in patients with spondylodiscitis. However, a number of additional novel and potentially important factors warrant consideration, including obesity, variations in pathogen source, poor nutritional status and inflammatory marks.","manuscriptTitle":"Prevalence, risk factors of mortality, and clinical outcomes in patients with spontaneous spinal infection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-26 12:34:49","doi":"10.21203/rs.3.rs-8116934/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30d7fb7b-2783-4fd1-b39e-de60548aab8c","owner":[],"postedDate":"February 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-31T17:54:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-26 12:34:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8116934","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8116934","identity":"rs-8116934","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}