Hamburg Assessment Score helps identify high risk patients of Spondylodiscitis

Hamburg, Germany:The novel Hamburg Spondylodiscitis Assessment Score (HSAS) by Heuer et al shows good fit identifying patients at low-, moderate-, high- and very high risk for in hospital mortality on admission.

Patients with spondylodiscitis often present after several weeks or months of progressively worsening symptoms, thus delaying the initiation of early treatment. When suspected, every effort should be made to enable rapid diagnostics starting with imaging, routine laboratory testing and identification of the pathogen by blood culture and/or biopsy of the infected intervertebral space or vertebral bone. Without accompanying neurological deficits, the prognosis is improved if antibiotic therapy and surgical management, if necessary, are initiated at an early stage. Despite advances in diagnostic modalities and increasing medical awareness spondylodiscitis is frequently overlooked, misdiagnosed or mismanaged due to non-specific symptoms. Unfortunately, delayed diagnosis of spondylodiscitis correlates with unfavourable treatment outcomes a swell as a mortality rate of up to 27%. A rapid initial triage is essential to identify patients at risk for a complicative disease course.

A retrospective data analysis of 307 patients with spondylodiscitis recruited from 2013 to 2020 was carried out. Patients were grouped according to all-cause mortality. Via logistic regression, individual patient and clinical characteristics predictive of mortality were identified.

Results: 14% of patients with spondylodiscitis died during their in-hospital stay at a tertiary center for spinal surgery. Univariate and logistic regression analyses of parameters recorded at hospital admission showed that age older than 72.5 years, rheumatoid arthritis, creatinine > 1.29 mg/dL and CRP > 140.5 mg/L increased the risk of mortality 3.9-fold, 9.4-fold, 4.3-fold and 4.1-fold, respectively. S. aureus detection increased the risk of mortality by 2.3-fold.

Age (>72.5 = 2 points), rheumatoid arthritis (3 points), creatinine (>1.29 = 2 points) and CRP (>140.5 = 2 points) were included in the development of a weighted risk score. An additional score point can be awarded when MSSA (methicillin-sensitive Staphylococcus aureus) is the causative pathogen (+1 point).

For practical application in practice the score is divided into four risk categories:

low risk (0 points),

moderate risk (1–3 points),

high risk (4–6 points) and

very high risk (7–10 points).

The implementation of the HSAS into clinical practice could ease identification of high-risk patients using readily available parameters alone, improving the patient's safety and outcome.

Further reading :

The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

Annika Heuer , André Strahl , Lennart Viezens , Leon-Gordian Koepke , Martin Stangenberg and Marc Dreimann 1

J. Clin. Med. 2022, 11, 660. https://doi.org/10.3390/jcm11030660