PROGNOSTIC FACTORS IN DEEP NECK INFECTION

Abstract

Objective: The present study aimed to evaluate the prognostic importance of hematologic test findings in addition to the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic inflammation response index, and C-reactive protein in the patients with deep neck infection and to compare these results with healthy subjects.

Material and Methods: The study included 32 patients diagnosed as deep neck infection and treated by surgical intervention and parenteral antibiotics. As none of the patients had life-threatening complications, the prognosis was determined by the length of stay in the hospital. The effect of age, sex, pre-treatment blood parameters, abscess culture results, and medical comorbidities on prognosis were analysed. Pre- and post-treatment blood parameters were compared in each patient. Blood parameters were also compared between healthy subjects and patients.

Results: When comparing patients with length of stay in the hospital ≤7 days and >7 days, significant differences were observed for age (t=-2.568, p=0.015) and red blood cell distribution width values obtained preoperatively (Z=-2.343, p=0.019). The correlation analysis revealed a positive correlation between age and length of stay in the hospital. (r=0.450, p=0.010), and between length of stay in the hospital and comorbidity (r=0.366, p=0.039). Logistic Regression analysis revealed that age could be the best marker in the prediction of the patients with worse prognosis (percentage of predicting patients with worse prognosis=73.3%, B=0.054, Wald=4.967, p=0.026).

Conclusion: The present study confirmed that the prognosis was worse in older patients and patients with comorbid disease whereas no relation was observed between the inflammatory markers and prognosis.

Keywords

• Neck
• abscess
• prognosis

Derin Boyun Enfeksiyonunda Prognostik Faktörler

Abstract

Amaç: Çalışmanın amacı derin boyun enfeksiyonu olan hastalarda nötrofil-lenfosit oranı, platelet-lenfosit oranı, monosit-lenfosit oranı, sistemik inflamasyon yanıt indeksi ve C-reaktif proteini de içeren hematolojik testlerin prognostik öneminin incelenmesi ve bu sonuçların sağlıklı bireylerle karşılaştırılmasıdır.

Gereç ve Yöntemler: Çalışmaya, derin boyun enfeksiyonu tanısı almış ve cerrahi ve parenteral antibiyoterapi ile tedavi edilmiş 32 hasta dahil edildi. Hiçbir hastada hayatı tehdit eden komplikasyona rastlanmadı ve prognoz belirteci olarak hastanede kalış süresi değerlendirildi. Yaş, cinsiyet, tedavi öncesi kan parametreleri, apse kültür sonucu ve medikal komorbiditelerin prognoza etkisi araştırıldı. Her hastada cerrahi öncesi ve sonrası kan değerleri kıyaslandı. Ayrıca hasta ve sağlıklı bireylerin kan sonuçları karşılaştırıldı.

Bulgular: Hastanede kalış süresi ≤7 gün ve >7 günden çok olan hastalar karşılaştırıldığında, yaş (t=-2.568, p=0.015) ve cerrahi öncesi eritrosit dağılım genişliği (Z=-2.343, p=0.019) değerleri açısından anlamlı fark saptandı. Korelasyon analizi sonrasında yaş ve hastanede kalış süresi arasında (r=0.450, p=0.010) ve hastanede kalış süresi ve komorbidite arasında (r=0.366, p=0.039) pozitif korelasyon tespit edildi. Lojistik regresyon analizi sonrası yaşın kötü prognozu öngörmede en iyi parametre olabileceği saptandı (kötü prognozlu hastaları öngörme yüzdesi: %73.3, B=0.054, Wald=4.967, p=0.026).

Sonuç: Bu çalışma, ileri yaş ve komorbiditesi olan hastalarda derin boyun enfeksiyonu prognozunun kötü olabileceğini desteklemiştir. İnflamatuar değerler ile prognoz arasında ilişki gözlenmedi.

Keywords

• Boyun
• apse
• prognoz

References

1. 1. Gabriel OT, Oyebanji O. A review and outcome of adenoidectomy performed in resource limited settings. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):1-4.
2. 2. Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854-60.
3. 3. Saluja S, Brietzke SE, Egan KK, Klavon S, Robson CD, Waltzman ML et al. A prospective study of 113 deep neck infections managed using a clinical practice guideline. Laryngoscope. 2013;123(12):3211-8.
4. 4. Bakir S, Tanriverdi MH, Gün R, Yorgancilar AE, Yildirim M, Tekbaş G et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33(1):56-63.
5. 5. Gallagher N, Collyer J, Bowe CM. Neutrophil to lymphocyte ratio as a prognostic marker of deep neck space infections secondary to odontogenic infection. Br J Oral Maxillofac Surg. 2021;59(2):228-32.
6. 6. Wang LF, Tai CF, Kuo WR, Chien CY. Predisposing factors of complicated deep neck infections: 12-year experience at a single institution. J Otolaryngol Head Neck Surg. 2010;39(4):335-41.
7. 7. Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V et al. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol. 2012;269(4):1241-9.
8. 8. Staffieri C, Fasanaro E, Favaretto N, La Torre FB, Sanguin S, Giacomelli L et al. Multivariate approach to investigating prognostic factors in deep neck infections. Eur Arch Otorhinolaryngol. 2014;271(7):2061-7.

9. 9. Kauffmann P, Cordesmeyer R, Tröltzsch M, Sömmer C, Laskawi R. Deep neck infections: A single-center analysis of 63 cases. Med Oral Patol Oral Cir Bucal. 2017;22(5):e536-e541.
10. 10. O'Brien KJ, Snapp KR, Dugan AJ, Westgate PM, Gupta N. Risk factors affecting length of stay in patients with deep neck space infection. Laryngoscope. 2020;130(9):2133-7.
11. 11. Velhonoja J, Lääveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol. 2020;277(3):863-72.
12. 12. Tapiovaara L, Bäck L, Aro K. Comparison of intubation and tracheotomy in patients with deep neck infection. Eur Arch Otorhinolaryngol. 2017;274(10):3767-72.
13. 13. Oya R, Takenaka Y, Imai T, Sato T, Oshima K, Ohta Y et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic hematologic markers of Bell's palsy: a meta-analysis. Otol Neurotol. 2019;40(5):681-7.
14. 14. Geng Y, Zhu D, Wu C, Wu J, Wang Q, Li R et al. A novel systemic inflammation response index (SIRI) for predicting postoperative survival of patients with esophageal squamous cell carcinoma. Int Immunopharmacol. 2018;65:503-10.
15. 15. Baglam T, Binnetoglu A, Yumusakhuylu AC, Gerin F, Demir B, Sari M. Predictive value of the neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute bacterial tonsillitis. Int J Pediatr Otorhinolaryngol. 2015;79(9):1421-4.
16. 16. Marioni G, Fasanaro E, Favaretto N, Trento G, Giacomelli L, Stramare R et al. Are panels of clinical, laboratory, radiological, and microbiological variables of prognostic value in deep neck infections? An analysis of 301 consecutive cases. Acta Otolaryngol. 2019;139(2):214-18.
17. 17. Liu SA, Liang MT, Wang CP, Wang CC, Lin WD, Ho HC et al. Preoperative blood sugar and C-reactive protein associated with persistent discharge after incision and drainage for patients with deep neck abscesses. Clin Otolaryngol. 2009;34(4):336-42.