The Predictive Value of Systemic Immune-Inflammation Index and Symptom Severity Score for Sepsis and Systemic Inflammatory Response Syndrome in Odontogenic Infections

Abstract

Acute Odontogenic Infections (OI) are the leading cause of emergency visits and hospitalizations to the maxillofacial department, and may induce systemic inflammatory complications. Increasing numbers of OI patients need extended hospitalizations, various treatments, and intensive care. The Symptom Severity score (SS) helps doctors assess the likelihood of infection and admission complications. Systemic Immune-inflammation Index (SII) is a biomarker-based inflammatory prognosis score. It was hypothesized that greater SII and SS values might suggest a higher risk for sepsis and systemic inflammatory response syndrome (SIRS). Therefore, this research aims to discover whether SII and SS scores can reliably predict odontogenic infection severity and prognosis, and if they can be used to predict the development of SIRS and sepsis in OI using admission features. The study was designed as a retrospective cohort, with patients’ data being retrieved from medical records between January 2017 to April 2022. A total of 108 OI patients were matched 1:1 as low-severity and high-severity groups. Most individuals with severe infections had diabetes and smoking as comorbidities. Severe patients had longer hospital stays (12.0 days vs. 4.1 days), although mortality rates did not significantly differ. A total of 11.1% lower-severity patients (Group A) had SIRS during hospitalization, compared to Group B with 25.9%. Group A had 7.4% of patients that developed sepsis compared to Group B’s rate of 22.2%. The correlation between OI’s SS and SII index values was positive and statistically significant (r = 0.6314). The total SII index mean was 1303, whereas the mean values by severity were 696.3 in Group A and 2312.4 in Group B. Group A’s mean SS score was 6.1, while Group B’s was 13.6. According to the calculated AUC plots, SII and SS scores were accurate predictors of sepsis and SIRS development using OI admission parameters. The adjusted odds ratio for SIRS in OI patients was 2.09, and 2.27 for sepsis. Medical professionals and dentistry teams should be encouraged to use the SII and SS scores to diagnose and anticipate sepsis and SIRS, hence improving disease management decisions.

Systemic immune-inflammation index combined with quick sequential organ failure assessment score for predicting mortality in sepsis patients

“…Inflammatory activity can be assessed through a series of indicators derived from peripheral blood tests, such as the white blood cells, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C -reaction protein that have been previously reported by scholars [ 36 , 37 ]. The SII was developed and combined three biomarkers of peripheral blood, including platelet, neutrophil, and lymphocyte count, presents as a comprehensive and robust indicator, which thoroughly sum up the balance of the host inflammatory and immunological status.…”

“…In a recent retrospective study conducted by Pricop et al a group of 108 patients with acute odontogenic infections were observed. The study revealed that the ratio of patients developing sepsis was accurately predicted by the SII score, which also demonstrated the potential to predict the development of systemic inflammatory response syndrome [ 37 ].…”

Impact of Treatment on Systemic Immune-Inflammatory Index and Other Inflammatory Markers in Odontogenic Cervicofacial Phlegmon Cases: A Retrospective Study

“…In the literature, a few studies have investigated the SII index in odontogenic cervicofacial phlegmons. Furthermore, in the case of deep odontogenic infections, its applicability has not yet been clearly established [ 29 ]. The values of the SII in our study significantly decreased after the surgical approach and pharmacological treatment of the cervicofacial phlegmons ( p = 0.012).…”

The predictive value of laboratory tests in oro‐maxillofacial infection of different severity

“…Recently, increasing attention has been given to finding an evaluation system that can predict the severity of OMHNSI. Although, acute physiology and chronic health score are used to indicate the severity of clinical conditions for patients (Pricop et al, 2022). However, they are complicated and inconvenient to be calculated.…”