Inflammatory Biomarkers and Platelet Indices in Odontogenic and Nonodontogenic Head and Neck Abscesses: A Prospective Observational Study.

introductionOdontogenic and nonodontogenic head and neck abscesses differ in their etiology and clinical presentation. However, data comparing inflammatory biomarkers and platelet (PLT) indices in these conditions remain limited. The aim was to compare serum procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), PLT, mean platelet volume (MPV), and the MPV-to-PLT ratio (MPR) between patients with odontogenic and nonodontogenic abscesses and to assess their associations with abscess origin and with each other.

methodsThis prospective observational study included 80 adult patients with head and neck abscesses (50 odontogenic and 30 nonodontogenic), hospitalized at the Clinic of Maxillofacial Surgery, University Hospital "St. Marina," Varna, Bulgaria, from the beginning of July 2021 to the end of June 2022. PLT indices (PLT and MPV) and WBC were obtained from a complete blood count analysis using an automated 5-part differential hematology analyzer (ADVIA 2020, Siemens Healthineers, Erlangen, Germany). CRP and PCT levels were quantified using immunoturbidimetric analysis (CRP on Cobas® 6000, Roche Diagnostics, Mannheim, Germany; PCT on ADVIA 1800, Siemens Healthineers). Statistical analyses were performed using the Statistical Package for the Social Sciences, version 19 (IBM Corp., Armonk, NY).

resultsCRP concentrations were significantly higher in patients with odontogenic abscesses than in those with nonodontogenic abscesses (68.79 (29.46-143.08) vs. 12.29 (3.46-41.32) mg/L, p < 0.001; rᵣᵦ = 0.55, 95% confidence interval (CI): 0.31-0.75). In contrast, no significant between-group differences were observed in PCT, WBC, PLT, MPV, or MPR (all p > 0.05). In multivariable analysis, higher PCT concentrations were independently associated with nonodontogenic abscess origin (adjusted odds ratio (OR) = 2.06, 95% CI: 1.23-3.45, p = 0.006), whereas higher CRP concentrations were associated with lower odds of nonodontogenic origin (adjusted OR = 0.981, 95% CI: 0.969-0.992, p = 0.001). Significant positive correlations between CRP and WBC were observed in both the odontogenic (ρ = 0.585, p < 0.001) and nonodontogenic (ρ = 0.546, p = 0.002) groups. In the nonodontogenic group, MPV was negatively correlated with PLT (ρ = -0.466, p = 0.010), while PLT was positively correlated with WBC (ρ = 0.442, p = 0.014). DISCUSSION: The findings indicate different patterns of association of CRP and PCT with abscess origin. Although only CRP differed significantly between the groups in the unadjusted analysis, multivariable analysis identified independent associations of both CRP and PCT with abscess origin. MPV and MPR appear to have limited value in distinguishing odontogenic from nonodontogenic abscesses.

conclusionCRP and PCT showed different patterns in the two types of head and neck abscesses. Although only CRP differed significantly between the groups in the unadjusted analysis, higher PCT was independently associated with nonodontogenic abscess origin, whereas higher CRP was associated with lower odds of nonodontogenic origin in multivariable analysis. PLT indices, including PLT, MPV, and MPR, showed no significant between-group differences.