New laboratory predictive tools in deep neck space infections

Abstract

SUMMARY Introduction Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement. Methods A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated. Results Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage. Conclusions Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.

Cavernous Sinus Involvement and Near Miss Mediastinitis following Mandibular Tooth Infection Treated during the COVID-19 Pandemic: Clinical Diagnosis and Treatment

“…On the other hand, there are no specific laboratory studies proven to be predictive of the NF diagnosis [ 79 ], although Fiorella et al propose the use of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score ( Table 3 ), the neutrophil-to-lymphocyte ratio (NLR), and LRINEC × NLR scores as predictive tools to early evaluate septic complications and the risk of CNF during DNSI. Indicator LRINEC×NLR was proposed by Fiorella et al to enhance the predictive value of the analysis [ 80 ]. LRINEC score was introduced by Wong et al to help clinicians access for NF checking on serum: white blood cell count, haemoglobin, sodium, glucose, creatinine, and C-reactive protein.…”

“…This indicated a medium risk of developing NF according to Wong et al and Chen et al [ 58 , 81 ] with 94% of sensitivity and specificity according to Sandner et al [ 36 ]. NLR score was 8.9 predicting systemic septic involvement (sensitivity and specificity rate of 74.2% and 61.5% above value of 8.2) and LRINEC×NLR score 53.4 indicating an important risk of CNF having a sensitivity of 90.9% above values of 43.5 according to Fiorella et al [ 80 ]. In this case report, it is possible to see how failure to apply the LRINEC score to early detect a rapidly developing necrotizing failure could potentially lead to either a mediastinitis or a life-threatening infection in the cranial fossae: the patient should have been screened in the emergency room and correctly directed into an intensive care ward rather than ENT ward to establish proper care, which happened only after 48 hours from hospitalization.…”

Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

“…We calculated the diagnostic accuracy (i.e., diagnostic odds ratio [DOR]) and created a summary receiver operating characteristic (SROC) curve to calculate the area under the curve (AUC). 3,5,9,14,15,[18][19][20][21] The DORs were calculated as (true positives  true negatives)/(false positives  false negatives), with 95% confidence intervals (CIs) using a random effect model taking into account both intrastudy and interstudy variations. DORs range from 0 to infinity, with high values indicating better diagnostic performance, and a value of 1 indicating that the presence of disease cannot be inferred.…”

Surgical multidisciplinary approach in the management of odontogenic or non-odontogenic neck infections

“…With the advent of modern antibiotics, the mortality rate associated with complications has significantly decreased 8 . The treatment of complications often requires a multidisciplinary surgical approach that can involve the otolaryngologist, the dentist, the maxillofacial and thoracic surgeons and sometimes the general surgeon.…”

“…The abscesses have many complications that affect the head-neck district. They are potentially lethal, and consist of upper airway obstruction, mediastinitis, necrotizing fascitis, thoracic empyema, jugular vein thrombosis, sepsis, orbital abscess and osteomyelitis [5][6][7][8] .…”