1425. Treatment Outcomes in Patients with Pyogenic Vertebral Osteomyelitis Who Have Cirrhosis

BACKGROUND: The mortality in liver cirrhosis was reported to be greater than that in the five major cancers. Infection further increases the mortality of patients with cirrhosis by four fold. Considering the greatly increased mortality from infection in patients with cirrhosis, early diagnosis and prompt treatments should be compulsory to save patients’ lives. However, adherence to such basic principle for patients with cirrhosis is not easy for clinicians engaged in the treatment of pyogenic vertebral osteomyelitis (PVO). Therefore, the mortality rate is expected to be high. However, no reports have described the mortality rate in this patient group. METHODS: A retrospective study was conducted to investigate the treatment outcome in PVO patients with cirrhosis, and to identify the predictors of their mortality. Mortality was divided into two categories, 30-day and 90-day mortality. A stepwise multivariate logistic regression model was used to identify predictors of mortality. Due to high mortality rate, the clinical outcome was investigated in patients with at least 90-day survival. RESULTS: Eighty-five patients were identified after initial exclusion. The patients’ mean age was 60.5 years, and 50 patients were male. The early mortality rates within 30 and 90 days were 17.6% and 36.5%, respectively (Table 1). Multivariate analysis revealed that increased age, CTP class C, and bacteremia at the time of PVO diagnosis were predictors of 30-day mortality while higher MELD score, presence of combined infection, and multiple spinal lesions were predictors of 90-day mortality (Figure 1, Table 2). The duration of antibiotic treatment and the length of hospital stay (from the PVO diagnosis) were longer in CTP C patients; however, they were statistically insignificant (Table 3). Recurrence of PVO was more common in CTP C patients (P = 0.028) (Table 3). CONCLUSION: Attention should be paid to the high mortality between 30 and 90 days after PVO diagnosis (18.8%), which was higher than the 30-day mortality. Liver function was consistently strong predictor of mortality in PVO patients with cirrhosis. The high-risk patients should be targeted for an aggressive diagnostic approach using spinal MRI and intensive medicosurgical treatment. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.