A scoring system for the preoperative evaluation of prognosis in spinal infection: the MSI-20 score.
Evaluation score
Infection
Mortality
Spinal infection, Spondylodiscitis
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
01
05
2021
revised:
09
11
2021
accepted:
20
12
2021
pubmed:
28
12
2021
medline:
11
5
2022
entrez:
27
12
2021
Statut:
ppublish
Résumé
Spinal infection (SI) is a life-threatening condition and its treatment remains challenging. Recent studies have supported early and aggressive surgery, but mortality still reaches 5% to 10% and it remains unclear, if an aggressive surgical strategy also applies for severely sick patients. The aim of this analysis was to generate an assessment score to predict mortality of SI in order to facilitate decision-making. Retrospective risk factor analysis. Two hundred fifty-two patients were retrospectively analyzed. Physiologic measures, functional measures. Diagnosis was based on clinical presentation, imaging findings and inflammatory markers. Factors associated with mortality were identified by multivariate analysis, weighted according to their relative risk ratio (RR) and included in the novel assessment score. Eight parameters were included: (1) BMI, (2) ASA score, (3) presence of sepsis, (4) age-adjusted Charlson Comorbidity Index, (5) presence and degree of renal failure, (6) presence of hepatopathy, (7) neurological deficits and (8) CRP levels at diagnosis. Each parameter was assigned a certain range of points, resulting in a maximum total score of 20. The mortality in spinal infection (MSI-20) score - indicating poorer status with higher values - was obtained for each patient and correlated with mortality. An MSI-20 score of 11 or more points seems to identify the small group of patients being "too sick to undergo surgery," while early surgery can be recommended in the remainder (MSI-20 ≤10). Our results need to be confirmed in prospective studies, but may give guidance for indicating surgery even in rather sick and comorbid patients.
Sections du résumé
BACKGROUND CONTEXT
Spinal infection (SI) is a life-threatening condition and its treatment remains challenging. Recent studies have supported early and aggressive surgery, but mortality still reaches 5% to 10% and it remains unclear, if an aggressive surgical strategy also applies for severely sick patients.
PURPOSE
The aim of this analysis was to generate an assessment score to predict mortality of SI in order to facilitate decision-making.
STUDY DESIGN
Retrospective risk factor analysis.
PATIENT SAMPLE
Two hundred fifty-two patients were retrospectively analyzed.
OUTCOME MEASURES
Physiologic measures, functional measures.
METHODS
Diagnosis was based on clinical presentation, imaging findings and inflammatory markers. Factors associated with mortality were identified by multivariate analysis, weighted according to their relative risk ratio (RR) and included in the novel assessment score.
RESULTS
Eight parameters were included: (1) BMI, (2) ASA score, (3) presence of sepsis, (4) age-adjusted Charlson Comorbidity Index, (5) presence and degree of renal failure, (6) presence of hepatopathy, (7) neurological deficits and (8) CRP levels at diagnosis. Each parameter was assigned a certain range of points, resulting in a maximum total score of 20. The mortality in spinal infection (MSI-20) score - indicating poorer status with higher values - was obtained for each patient and correlated with mortality.
CONCLUSION
An MSI-20 score of 11 or more points seems to identify the small group of patients being "too sick to undergo surgery," while early surgery can be recommended in the remainder (MSI-20 ≤10). Our results need to be confirmed in prospective studies, but may give guidance for indicating surgery even in rather sick and comorbid patients.
Identifiants
pubmed: 34958935
pii: S1529-9430(21)01094-9
doi: 10.1016/j.spinee.2021.12.015
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
827-834Commentaires et corrections
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Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.