Hemodiyaliz Hastalarinda Spondilodiskitis

Amaç: Hemodiyaliz immünsupresyon yaratmasının yanı sıra hastaların damar girişimlerine ve operatif prosedürlere daha sık maruz kalmaları nedeniyle enfeksiyon riskini arttırmaktadır. Amacımız hemodiyaliz hastalarında spondilodiskitis oranını, olası etkenleri ve hastalığa erken tanı konmasına yardımcı olabilecek parametreleri ortaya koymaktır. Materyal ve Metot: 2010-2020 tarihleri arasında hemodiyaliz ünitesinde tedavi alan hastalar çalışmaya dahil edildi. Bel ağrısı şikayeti olan hastaların verilerine Mia-Med hasta kayıt sisteminden retrospektif olarak ulaşıldı. Bulgular: Spondilodiskitis sıklığı %2,3 idi. Diyaliz süresinin uzaması (p<0,001), kateter kullanımı (p=0,005), diabetes mellitus (p=0,029) ve kalp yetmezliği (p=0,005) varlığının diskitis riskini arttırdığı saptandı. Spondilodiskitis bulunanlarda lökosit (p<0,001), nötrofil lenfosit oranı (NLO) (p=0,006), trombosit lenfosit oranı (TLO) (p=0,001), sedimentasyon (p<0,001) ve C- reaktif protein (CRP) (p<0,001) değerleri anlamlı olarak yüksek idi. Sonuç: Spondilodiskitis komorbiditesi olan, hemodiyaliz süresi uzun, kateter kullanılan ve ileri yaştaki hastalarda daha sık ortaya çıkmaktadır. Hızlı tanı için lökositoz, CRP, sedimantasyon gibi tetkikler kullanılabilir. Ayrıca tam kan tetkik sonuçlarından kolaylıkla hesaplanabilen NLR ve TLR, tanıda kullanılabilecek parametrelerdir.

Anahtar Kelimeler:

Hematolojik parametreler, Hemodiyaliz, Spondilodiskitis

Spondylodiscitis in Patients under Haemodyalisis

Objective: In addition to causing immunosuppression, hemodialysis may increase the risk of infection, given that the patients are more frequently exposed to vascular interventions and operative procedures. The present study aims to reveal the prevalence of spondylodiscitis in patients on hemodialysis, potential factors, and parameters that may help in the early diagnosis of the disease. Materials and Methods: Patients who received treatment in the hemodialysis unit between 2010 and 2020 were included in the present study. Data of patients with low back pain were obtained retrospectively from the Mia-Med patient registry system. Results: The frequency of spondylodiscitis was 2.3%. Findings showed that the prolonged dialysis duration (p<0.001), catheter use (p=0.005), diabetes mellitus (p=0.029), and heart failure (p=0.005) increased the risk of discitis. Leukocyte (p<0.001), neutrophil-to-lymphocyte ratio (NLR) (p=0.006), platelet-to-lymphocyte ratio (PLR) (p=0.001), sedimentation (p<0.001) and C-reactive protein (CRP) (p<0.001) levels were significantly higher in patients with spondylodiscitis. Conclusion: Spondylodiscitis occurs more prevalently in patients with comorbidity, have long hemodialysis duration, use catheters and in elderly patients. Leukocytosis, CRP, sedimentation can be used for rapid diagnosis. In addition, NLR and TLR, which can be easily calculated from the results of whole blood tests, are parameters that can be used in diagnosis.

Keywords:

Hematological parameters, Hemodialysis, Spondylodiscitis,

PDF

___

Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R. Spondylodiscitis: Diagnosis and treatment options. Dtsch Arztebl Int. 2017;114(51-52):875-882. doi:10.3238/arztebl.2017.0875
Waheed G, Soliman MAR, Ali AM, Aly MH. Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients. Neurosurg Focus. 2019;46(1): E10. doi:10.3171/2018.10.FOCUS18463
Kapsalaki E, Gatselis N, Stefos A, et al. Spontaneous spondylodiscitis: Presentation, risk factors, diagnosis, management, and outcome. Int J Infect Dis. 2009;13(5):564-569. doi:10.1016/j.ijid.2008.08.025
Lu YA, Hsu HH, Kao HK, et al. Infective spondylodiscitis in patients on maintenance hemodialysis: A case series. Ren Fail. 2017;39(1):179-186. doi:10.1080/0886022X.2016.1256313
Helewa RM, Embil JM, Boughen CG, et al. Risk factors for infectious spondylodiscitis in patients receiving hemodialysis. Infect Control Hosp Epidemiol. 2008;29(6):567-571. doi:10.1086/588202
Amini MH, Salzman GA. Infectious spondylodiscitis: diagnosis and treatment. Mo Med. 2013;110(1):80-84.
Asamoto S, Doi H, Kobayashi N, et al. Spondylodiscitis: diagnosis and treatment. Surg Neurol. 2005;64(2):103-108. doi:10.1016/j.surneu.2004.11.034
Afshar M, Reilly RF. Spondylodiscitis in a patient on chronic hemodialysis. Nat Rev Nephrol. 2011;7(10):599-604. doi:10.1038/nrneph.2011.105
Tsuchiya K, Yamaoka K, Tanaka K, Sasaki T. Bacterial spondylodiscitis in the patients with hemodialysis. Spine (Phila Pa 1976). 2000;29(22):2533-2537. doi:10.1097/01.brs.0000144831.09982.06
Cervan AM, Colmenero Jde D, Del Arco A, Villanueva F, Guerado E. Spondylodiscitis in patients under haemodyalisis. Int Orthop. 2012;36(2):421-426. doi:10.1007/s00264-011-1433-1
Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: Update on diagnosis and management. J Antimicrob Chemother. 2010;65(Suppl3):iii11–iii24. doi:10.1093/jac/dkq303
García-García P, Rivero A, del Castillo N, et al. Infectious spondylodiscitis in hemodialysis. Semin Dial. 2010;23(6):619–626. doi:10.1111/j.1525139X.2010.00791.x
Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S. Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol. 2002;23(12):716-720. doi:10.1086/501999
Abdulrahman IS, Al-Mueilo SH, Bokhary HA, Ladipo GOA, Al-Rubaish A. A prospective study of hemodialysis access-related bacterial infections. J Infect Chemother. 2002;8(3):242-246. doi:10.1007/s10156-002-0184-8
Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95. Scand J Infect Dis. 2001;33(7):527-532. doi:10.1080/00365540110026566
Huang W, Huang J, Liu Q, et al. Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy. Clin Endocrinol. 2014;82(2):229-233. doi:10.1111/cen.12576
Ozer S, Yılmaz R, Sonmezgoz E, et al. Simple markers for subclinical inflammation in patients with mediterranene fever. Med Sci Monit. 2015;21:298-303. doi:10.12659/MSM.892289
Polat M, Bugdayci G, Kaya H, Oğuzman H. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26(4):97-100. doi:10.15570/actaapa.2017.28