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. 2024 May;14(4):1296-1303.
doi: 10.1177/21925682221139801. Epub 2023 Feb 18.

Early Reduction in C-Reactive Protein Following Treatment for Spinal Epidural Abscess: A Potential Treatment Guide

Sarah Hunter  1 , Cindy Ou  1 , Joseph F Baker  1   2
Affiliations

Early Reduction in C-Reactive Protein Following Treatment for Spinal Epidural Abscess: A Potential Treatment Guide

Sarah Hunter et al. Global Spine J. 2024 May.

Abstract

Study design: Retrospective Cohort Study.

Objective: To assess the predictive value of early C-reactive protein (CRP) trends following diagnosis of spinal epidural abscess (SEA). Non-operative management with intravenous antibiotics has not demonstrated equivalent outcomes with regard to mortality and morbidity. Knowledge of specific patient and disease factors associated with worse outcomes may predict treatment failure.

Methods: All patients treated for spontaneous SEA in a tertiary centre in New Zealand over a 10-year period were followed for at least 2 years. CRP at diagnosis and day 4-5 following treatment initiation was analyzed to determine predictors of CRP reduction of at least 50%. Proportional Cox hazards regression investigated mortality over 2 years.

Results: 94 patients met inclusion criteria and with CRP values available for analysis. Median age was 62 years (+/- 17.7) and 59 (63%) were treated operatively. Kaplan-Meier analysis estimate of 2-year survival was .81 (95% CI .72-.88). CRP reduction by 50% was seen in 34 patients. Patients who did not experience a 50% reduction were more likely to have thoracic infection (27 vs 8, P = .02) or multifocal sepsis (41 vs 13, P = .002). Failure to achieve a 50% reduction by day 4-5 was associated with worse post-treatment Karnofsky scores (70 vs 90, P = .03) and longer hospital stay (25 days vs 17.5 days, P = .04). Cox regression model showed mortality predicted by Charlson Comorbidity Index, thoracic location of infection, pre-treatment Karnofsky score, and failure to achieve a 50% CRP reduction by day 4-5.

Conclusions: Patients who fail to reduce CRP values by 50% at day 4-5 following treatment initiation are more likely to experience prolonged hospital stay, have poorer functional outcome and have greater mortality risk at 2 years. This group has severe illness regardless of treatment type. Failure to achieve a biochemical response to treatment should prompt reassessment.

Keywords: conservative management; epidural abscess; pyogenic spinal column infection; treatment failure.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Early trends in median C-reactive protein.
Figure 2.
Figure 2.
Kaplan-Meier survival estimate over 2 -year follow-up.
Figure 3.
Figure 3.
CRP trends For Operatively and Non-Operatively Managed Patients.
Figure 4.
Figure 4.
Kaplan- Meier survival analysis with and without CRP resolution.
See this image and copyright information in PMC

References

    1. Artenstein AW, Friderici J, Holers A, et al. Spinal epidural abscess in adults: A 10-year clinical experience at a tertiary care academic medical center. Open Forum Infect Dis. 2016;3. doi:10.1093/ofid/ofw191 - DOI - PMC - PubMed
    1. Arko L, Quach E, Nguyen V, et al. Medical and surgical management of spinal epidural abscess: A systematic review. Neurosurg Focus. 2014;37:1-9. - PubMed
    1. de Leeuw CN, Fann PR, Tanenbaum JE, et al. Lumbar epidural abscesses: A systematic review. Global Spine J. 2018. doi:10.1177/2192568218763323 - DOI - PMC - PubMed
    1. Epstein NE. What are we waiting for? An argument for early surgery for spinal epidural abscesses. Surg Neurol Int. 2015. doi:10.4103/2152-7806.166894 - DOI - PMC - PubMed
    1. Karhade AV, Shah AA, Bono CM, et al. Development of machine learning algorithms for prediction of mortality in spinal epidural abscess. Spine J. 2019. doi:10.1016/j.spinee.2019.06.024 - DOI - PubMed

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