First-4-week erythrocyte sedimentation rate variability predicts erythrocyte sedimentation rate trajectories and clinical course among patients with pyogenic vertebral osteomyelitis


Autoři: Hsiu-Yin Chiang aff001;  Chih-Wei Chung aff001;  Chin-Chi Kuo aff001;  Yen-Chun Lo aff001;  Wei-Shuo Chang aff003;  Chih-Yu Chi aff004
Působiště autorů: Big Data Center, China Medical University Hospital, Taichung, Taiwan aff001;  Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan aff002;  Division of Infectious Diseases, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan aff003;  Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan aff004;  School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0225969

Souhrn

Background

The trajectory pattern of erythrocyte sedimentation rate (ESR) in patients with pyogenic vertebral osteomyelitis (PVO) and its clinical significance is unclear. We further evaluated whether the first-4-week ESR variability can predict the trajectory pattern, treatment duration and recurrence of PVO.

Methods

The longitudinal ESR patterns of adults with PVO within the first 6 months were characterized through group-based trajectory modeling (GBTM). The ESR variability within the first 4 weeks was defined using the absolute difference (AD), coefficient of variation, percent change, and slope change. The first-4-week ESR variabilities were analyzed using ordinal logistic regression to predict the 6-month ESR trajectory and using logistic regression to predict treatment duration and recurrence likelihood. The discrimination and calibration of the prediction models were evaluated.

Results

Three ESR trajectory patterns were identified though GBTM among patients with PVO: Group 1, initial moderate high ESR with fast response; Group 2, initial high ESR with fast response; Group 3, initial high ESR with slow response. Group 3 patients (initial high ESR with slow response) were older, received longer antibiotic treatment, and had more comorbidities and higher recurrence rates than patients in the other two groups. The initial ESR value and ESR − AD could predict the 6-month ESR trajectory. By incorporating the first-4-week ESR variabilities and the clinical features of patients, our models exhibited moderate discrimination performance to predict prolonged treatment (≥12 weeks; C statistic, 0.75; 95% confidence interval [CI], 0.70 to 0.81) and recurrence (C statistic, 0.69; 95% CI, 0.61 to 0.78).

Conclusions

The initial ESR value and first-4-week ESR variability are useful markers to predict the treatment duration and recurrence of PVO. Future studies should validate our findings in other populations.

Klíčová slova:

Antibiotics – Chronic kidney disease – Osteomyelitis – Red blood cells – Sedimentation – Surgical and invasive medical procedures – Abscesses


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