Clin Exp Otorhinolaryngol.  2018 Dec;11(4):293-300. 10.21053/ceo.2018.00108.

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

• Park MJ
• Kim JW
• Kim Y
• Lee YS
• Roh JL
• Choi SH
• Kim SY
• Nam SY

• KMID: 2439857
• DOI: http://doi.org/10.21053/ceo.2018.00108

Abstract

OBJECTIVES
The current study aims to determine the correlation between nutritional status upon presentation and disease severity, as well as treatment and survival outcomes.
METHODS
Patients 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.
RESULTS
A 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.
CONCLUSION
Among 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.

Keyword

Retrophnarynx Abscess; Fasciitis; Necrotizing; Hypoalbuminemia; Malnutrition; Drainage

MeSH Terms

Body Mass Index
C-Reactive Protein
Comorbidity
Drainage
Fasciitis
Fasciitis, Necrotizing
Follow-Up Studies
Hospitalization
Humans
Hypoalbuminemia
Malnutrition
Mediastinitis
Neck*
Nutritional Status*
Odds Ratio
Retrospective Studies
Serum Albumin
C-Reactive Protein
Serum Albumin

Figure

• 

  Fig. 1. Overall survival and response to treatment according to the initial serum albumin level. Kaplan-Meier curves estimating the overall survival (A) and more than 50% reduction in initial serum C-reactive protein (CRP) (B), suggesting lower treatment responses and worse clinical outcomes in patients with initial hypoalbuminemia (P<0.05, both). Log-rank test, P<0.05.

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