Wasting phenotype for differentiating spinal tuberculosis from spinal pyogenic infection.

Area of Science:

• Infectious Diseases
• Clinical Diagnostics
• Biochemistry

Background:

• Spinal tuberculosis (STB) and pyogenic spinal infection (PSI) share overlapping symptoms, complicating early diagnosis and treatment.
• Developing reliable laboratory markers is crucial for differentiating STB from PSI.

Purpose of the Study:

• To identify clinical and laboratory indicators related to wasting phenotype for differentiating STB from PSI.
• To develop a practical diagnostic model for clinical use.

Main Methods:

• A prospective study enrolled 253 patients with confirmed spinal infections (159 STB, 94 PSI).
• Demographic, clinical, and laboratory data were collected, with eight metabolic and inflammatory variables assessed.
• Multivariable logistic regression and ROC analysis were used to develop and evaluate a diagnostic model.

Main Results:

• Lower body temperature, lower blood glucose, and higher high-density lipoprotein (HDL) were independently associated with STB.
• The diagnostic model showed moderate discrimination (AUC=0.673) and good calibration.
• Optimal thresholds were identified: temperature ≤36.7°C, HDL ≥0.89 mmol/L, and blood glucose ≤5.85 mmol/L.

Conclusions:

• A composite wasting phenotype (low temperature, low glucose, high HDL) aids in differentiating STB from PSI.
• The developed model offers a biologically plausible, interpretable, and clinically useful tool for managing spinal infections.
• Individual thresholds have limited diagnostic value, but the combined model supports clinical decision-making.