Initial Nutritional Status and Clinical Outcomes in Patients with Deep Neck Infection

Abstract

ObjectivesThe current study aims to determine the correlation between nutritional status upon presentation and disease severity, as well as treatment and survival outcomes.MethodsPatients who were diagnosed with deep neck infection, underwent at least one surgical drainage/debridement, and had more than 1 week of hospitalization at a tertiary medical center from 2007 to 2015 were retrospectively included. Thereafter, initial serum albumin, C-reactive protein (CRP), and body mass index (BMI) were reviewed.ResultsA total of 135 patients were included in the final analysis. Accordingly, the proportion of patients with simultaneous mediastinitis (21.0%), necrotizing fasciitis (12.9%), disease extent >1 cervical level (72.6%), mean CRP (22.4 mg/dL), mean length of hospitalization (25.0 days), and mean 1-week follow-up CRP (7.2 mg/dL) was significantly higher in the hypoalbuminemia group (initial serum albumin <3.0 g/dL) than in the normoalbuminemia group (all P<0.05). No significant correlations had been observed according to BMI status. After adjusting for age and Charlson comorbidity index, odds ratios for the following outcomes were calculated in patients initially presenting with hypoalbuminemia: simultaneous mediastinitis (3.07), necrotizing fasciitis (7.89), disease extent >1 cervical level (2.12), initial serum CRP over 20 mg/dL (3.79), hospitalization of more than 14 days (4.10), 1-week follow-up CRP over 5 mg/dL (3.78), and increased duration for an over 50% decrease in initial CRP (2.70) (all P<0.05). Although intravascular albumin replenishment decreased the proportion of patients with hypoalbuminemia after 2 weeks (P<0.05), it did not significantly predict better treatment outcomes.ConclusionAmong the markers reflecting an individual’s nutritional state, an initial serum albumin of less than 3.0 g/dL was an independent serologic marker predicting increased disease severity and complications in patients with deep neck infection.

Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients

“…Accordingly, abscess formation in the present study was mainly localized in carotid, submandibular, parapharyngeal and parotid spaces. Involvement of the mediastinum was shown in 20.64%, which is somewhat higher than the proportions reported in literature with 4–11% [ 11 , 14 ]. Besides regional or demographic differences, this might also be a selection bias, since our institution as a tertiary university hospital probably has a higher proportion of severe cases.…”

“…Because of the oral and pharyngeal origin of these infections, the most common pathogens responsible are aerobic bacteria like Streptococcus pyogenes and Staphylococcus aureus, while anaerobic bacteria are found less frequently [6][7][8]. Several risk factors for the development of severe deep neck infections and an affection of the mediastinum have been identified, such as age older than 55 years [9], cardiopulmonary comorbidities [10], nutritional status [11] or especially diabetes mellitus [12]. While the original infections can be diagnosed quickly due to the specific symptoms, the diagnosis of the spreading along the cervical fascial planes into the mediastinum is often delayed because of the unspecific additional symptoms until clinical deterioration [3,4].…”

The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces

“…However, the DNI is still an emergent condition in otolaryngology, which can lead to serious complications such as airway obstruction, jugular vein thrombosis, carotid artery erosion, cranial nerve paresis, meningitis, mediastinitis, vertebra osteomyelitis, and sepsis. [1][2][3][4] Deep neck infections are usually originating from upper aerodigestive tract diseases, especially tonsillitis and dental infections. In children, the predominant focus of DNI is infection of the tonsils and pharynx, while in adult patients, the increase in the dental etiology is observed.…”

Tumor‐related leukocytosis predictive of recurrence and survival in patients with oral cavity squamous cell carcinoma

“…Clinical characteristics of patients were reviewed, including age at diagnosis (>60 years old), sex, history of smoking (≥20 pack‐years), alcohol consumption (≥1 drink/day), Karnofsky performance status (≤80), Charlson's comorbidity index (Etienne et al, ), tumor site and extent and gross node and extranodal extension involvement, and postoperative treatment. The reference limits of baseline biomarkers in laboratory findings were defined from previous reports and our institutional normal ranges as TRL (white blood cell count > 10,000/μl; Mabuchi et al, ; Schernberg, Escande, et al, ), anemia (<11 g/dl in both genders) (Holgersson et al, ), hypoalbuminemia (<3.5 g/dl; Park, Kim, et al, ; Park, Roh, et al, ), hypoproteinemia (<6.0 g/dl; Park, Roh, et al, ), neutrophilia (>7,500/μl; Schernberg, Escande, et al, ), lymphocytopenia (<1,000/μl; Schernberg, Moureau‐Zabotto, et al, ), monocytosis (>1,000/μl; Schernberg, Moureau‐Zabotto, et al, ), thrombophilia (>350 × 10 3 /μl; Holgersson et al, ; Schernberg, Moureau‐Zabotto, et al, ), neutrophil–lymphocyte ratio (>2.5) (Cho et al, ), platelet–lymphocyte ratio (>200) (Park, Roh, et al, ), and monocyte–lymphocyte ratio (>0.5) (Cho et al, ). Pathological factors of patients included tumor site (others/oral tongue) and extent, size (≤2/2.1–4/>4 cm) (Amin et al, ; Edge et al, ), invasion depth (≤5/5.1–10/>10 cm; Amin et al, ), differentiation (well/moderately/poorly), perineural and lymphovascular invasion (Geweiler, Inhestern, Berndt, & Guntinas‐Lichius, ), and resection margins (involved).…”