{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:15:59Z","timestamp":1793391359313,"version":"4.5.0"},"reference-count":29,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: There is a marked proportion of spondylodiscitis patients who die during the early stage of the disease despite the applied therapy. This study investigates this early mortality and explores the associated risk factors. (2) Methods: We conducted a retrospective analysis of spondylodiscitis patients treated at our Level I spine center between 1 January 2018 and 31 December 2022. (3) Results: Among 430 patients, 32 (7.4%) died during their hospital stay, with a median time of 28.5 days (range: 2.0\u201384.0 days). Six of these patients (18.75%) did not undergo surgery due to dire clinical conditions or death prior to scheduled surgery. Identified causes of in-hospital death included multiorgan failure (n = 15), acute bone marrow failure (2), cardiac failure (4), liver failure (2), acute respiratory failure (2), acute renal failure (1), and concomitant oncological disease (1). In a simple logistic regression analysis, advanced age (p = 0.0006), diabetes mellitus (p = 0.0002), previous steroid medication (p = 0.0279), Charlson Comorbidity Index (p &lt; 0.0001), and GFR level at admission (p = 0.0008) were significant risk factors for in-hospital death. In a multiple logistic regression analysis, advanced age (p = 0.0038), diabetes mellitus (p = 0.0002), and previous steroid medication (p = 0.0281) remained significant. (4) Conclusions: Despite immediate treatment, a subset of spondylodiscitis patients experience early mortality. Particular attention should be given to elderly patients and those with diabetes or a history of steroid medication, as they face an elevated risk of a rapidly progressing and fatal disease.<\/jats:p>","DOI":"10.3390\/jcm12237228","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T04:21:27Z","timestamp":1700626887000},"page":"7228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["In-Hospital Mortality from Spondylodiscitis: Insights from a Single-Center Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7514-9350","authenticated-orcid":false,"given":"Ann-Kathrin","family":"Joerger","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6486-7955","authenticated-orcid":false,"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6439-3665","authenticated-orcid":false,"given":"Maria","family":"Wostrack","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lang, S., Walter, N., Schindler, M., Baertl, S., Szymski, D., Loibl, M., Alt, V., and Rupp, M. (2023). The Epidemiology of Spondylodiscitis in Germany: A Descriptive Report of Incidence Rates, Pathogens, In-Hospital Mortality, and Hospital Stays between 2010 and 2020. J. Clin. Med., 12.","DOI":"10.3390\/jcm12103373"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E102","DOI":"10.1097\/BSD.0000000000000597","article-title":"The Epidemiology of Vertebral Osteomyelitis in the United States from 1998 to 2013","volume":"31","author":"Issa","year":"2018","journal-title":"Clin. Spine Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1017\/S0950268821002181","article-title":"Large increase of vertebral osteomyelitis in France: A 2010\u20132019 cross-sectional study","volume":"149","author":"Conan","year":"2021","journal-title":"Epidemiol. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jinf.2013.11.011","article-title":"Increasing incidence of pyogenic spondylodiscitis: A 14-year population-based study","volume":"68","author":"Kehrer","year":"2014","journal-title":"J. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Puth, M.T., Weckbecker, K., Schmid, M., and Munster, E. (2017). Prevalence of multimorbidity in Germany: Impact of age and educational level in a cross-sectional study on 19,294 adults. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4833-3"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"73S","DOI":"10.1177\/21925682221121300","article-title":"Spondylodiscitis in Geriatric Patients: What Are the Issues?","volume":"13","author":"Herren","year":"2023","journal-title":"Global Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1007\/s00259-017-3912-0","article-title":"The diagnostic value of (18)F-FDG-PET\/CT and MRI in suspected vertebral osteomyelitis\u2014A prospective study","volume":"45","author":"Kouijzer","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00701-018-3467-2","article-title":"Management of spinal infection: A review of the literature","volume":"160","author":"Lener","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.semarthrit.2008.03.002","article-title":"Pyogenic vertebral osteomyelitis: A systematic review of clinical characteristics","volume":"39","author":"Mylona","year":"2009","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1007\/s00701-019-03985-3","article-title":"Treatment considerations for cervical and cervicothoracic spondylodiscitis associated with esophageal fistula due to cancer history or accidental injury: A 9-patient case series","volume":"161","author":"Janssen","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S1529-9430(02)00203-6","article-title":"Management of postprocedural discitis","volume":"2","author":"Silber","year":"2002","journal-title":"Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1055\/a-1324-4424","article-title":"Zusammenfassung der S2K-Leitlinie \u201cDiagnostik und Therapie der Spondylodiszitis\u201d (Stand 08\/2020)","volume":"5","author":"Herren","year":"2021","journal-title":"Die Wirbels\u00e4ule"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1093\/cid\/civ482","article-title":"2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults","volume":"61","author":"Berbari","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00586-015-4318-y","article-title":"Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: A systematic literature review","volume":"25","author":"Rutges","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Heuer, A., Strahl, A., Viezens, L., Koepke, L.G., Stangenberg, M., and Dreimann, M. (2022). The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030660"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e002412","DOI":"10.1136\/bmjopen-2012-002412","article-title":"Incidence and risk factors for mortality of vertebral osteomyelitis: A retrospective analysis using the Japanese diagnosis procedure combination database","volume":"3","author":"Akiyama","year":"2013","journal-title":"BMJ Open"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Widdrington, J.D., Emmerson, I., Cullinan, M., Narayanan, M., Klejnow, E., Watson, A., Ong, E.L.C., Schmid, M.L., Price, D.A., and Schwab, U. (2018). Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice. Med. Sci., 6.","DOI":"10.3390\/medsci6040096"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lang, S., Fromming, A., Walter, N., Freigang, V., Neumann, C., Loibl, M., Ehrenschwender, M., Alt, V., and Rupp, M. (2021). Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?. Antibiotics, 10.","DOI":"10.3390\/antibiotics10111410"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1007\/s00586-023-07578-8","article-title":"Correlation between kidney function and mortality in pyogenic spondylodiscitis: The glomerular filtration rate (GFR) as new predictive parameter?","volume":"32","author":"Lenz","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s15010-013-0582-0","article-title":"Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital","volume":"42","author":"Loibl","year":"2014","journal-title":"Infection"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00132-020-03945-1","article-title":"Pyogenic spondylodiscitis: Symptoms, diagnostics and therapeutic strategies","volume":"49","author":"Ryang","year":"2020","journal-title":"Orthopade"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1007\/s00701-021-04744-z","article-title":"Minimally invasive posterior pedicle screw fixation versus open instrumentation in patients with thoracolumbar spondylodiscitis","volume":"163","author":"Janssen","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1007\/s00701-020-04507-2","article-title":"Early surgery may lower mortality in patients suffering from severe spinal infection","volume":"162","author":"Lener","year":"2020","journal-title":"Acta Neurochir."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.jiph.2023.04.010","article-title":"The epidemiology of concurrent infection in patients with pyogenic spine infection and its association with early mortality: A nationwide cohort study based on 10,695 patients","volume":"16","author":"Kim","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1086\/340102","article-title":"Vertebral osteomyelitis: Long-term outcome for 253 patients from 7 Cleveland-area hospitals","volume":"34","author":"McHenry","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1055\/s-0040-1721005","article-title":"Distribution of Underlying Causative Organisms, Patient Age, and Survival in Spontaneous spondylodiscitis with Special Focus on Elderly Patients","volume":"84","author":"Lackermair","year":"2023","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_27","first-page":"875","article-title":"Spondylodiscitis: Diagnosis and Treatment Options","volume":"114","author":"Herren","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/S0140-6736(14)61233-2","article-title":"Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: An open-label, non-inferiority, randomised, controlled trial","volume":"385","author":"Bernard","year":"2015","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s15010-021-01642-5","article-title":"Influence of microbiological diagnosis on the clinical course of spondylodiscitis","volume":"49","author":"Stangenberg","year":"2021","journal-title":"Infection"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/23\/7228\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:26:49Z","timestamp":1760131609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/23\/7228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,22]]},"references-count":29,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcm12237228"],"URL":"https:\/\/doi.org\/10.3390\/jcm12237228","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,22]]}}}