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Prognostic factors for unfavourable outcomes of patients with spinal tuberculosis in a country with an intermediate tuberculosis burden: a multicentre cohort study

Authors
 Jung Ho Kim  ;  Jin Young Ahn  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Jun Yong Choi  ;  Young Keun Kim  ;  Joon-Sup Yeom  ;  Young Goo Song 
Citation
 BONE & JOINT JOURNAL, Vol.101-B(12) : 1542-1549, 2019 
Journal Title
 BONE & JOINT JOURNAL 
ISSN
 2049-4394 
Issue Date
2019
MeSH
Adult ; Aged ; Antitubercular Agents/therapeutic use* ; Biomarkers/blood ; Blood Sedimentation ; Combined Modality Therapy ; Cost of Illness ; Female ; Follow-Up Studies ; Humans ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Orthopedic Procedures*/methods ; Prognosis ; Republic of Korea ; Retrospective Studies ; Treatment Outcome ; Tuberculosis, Spinal/blood ; Tuberculosis, Spinal/diagnosis* ; Tuberculosis, Spinal/therapy*
Keywords
Erythrocyte sedimentation rate ; Outcome ; Prognostic factor ; Spinal tuberculosis
Abstract
AIMS: Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. PATIENTS AND METHODS: We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. RESULTS: In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. CONCLUSION: Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes.
Full Text
https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.101B12.BJJ-2019-0558.R1
DOI
10.1302/0301-620X.101B12.BJJ-2019-0558.R1
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, Jung Ho(김정호) ORCID logo https://orcid.org/0000-0002-5033-3482
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Yeom, Joon Sup(염준섭) ORCID logo https://orcid.org/0000-0001-8940-7170
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174797
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