Page 35 - Revista Portuguesa - SPORL - Vol 61. Nº4
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countries. In the present study, the most dynamic alterations that may even precede
frequent isolated bacteria were Streptococcus the alterations in the clinical state . Thus,
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anginosus, Streptococcus constellatus, NLR should be determined in every patient
and anaerobic species, the most common with DNI in order to assess the probability of
being Prevotella spp. In accordance with complications such as mediastinitis. Since
the findings of Kimura et al., the bacteria CRP is an acute inflammatory protein with
isolated in patients with DNI with and without higher levels associated with sepsis and
mediastinitis seemed to be similar . poor prognosis , it was expected that there
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DNI may rapidly spread through the neck would be an association between CRP and
to the mediastinum, leading to potential mediastinitis, but it was not found in the
life-threatening complications such as present study. Although further studies are
mediastinitis, necrotizing fasciitis, Lemierre’s required to explore if CRP might be a potential
Syndrome, cavernous sinus thrombosis, clinical predictor of complications of DNI,
carotid artery rupture, and death. Thus, it is our results show that NLR might be a more
important to be aware of the factors that can significant clinical predictor in comparison to
potentially lead to these complications to CRP.
optimize the treatment in patients with DNI. CT parameters may also be adequate to
Older age at presentation was associated with predict progression to mediastinitis . In
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progression to mediastinitis in the present the present study, there was an association
study. Previous studies have also shown that with the highest dimensions on CT scan,
older age in patients with DNI is associated presence of gas, and infra-hyoid extension.
with the involvement of multiple spaces, Furthermore, involvement of parapharyngeal,
complications, multiple surgical interventions, retropharyngeal, prevertebral, or visceral
and prolonged hospitalization . Although spaces was associated with risk of mediastinitis,
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we found no association between DM and in accordance with what has been previously
progression to mediastinitis, a meta-analysis reported 8, 11 . In contrast, we have found no
reported that DM was associated with a previous reports of a protective association
higher rate of complications and involvement between submandibular space involvement
of multiple spaces . While tonsillitis was and DNI complications.
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associated with progression to mediastinitis This study had a large sample size compared to
in the present study, other studies did not find those of most previous studies, which enabled
any association 4, 11 . Further studies are required an adjusted analysis of clinical predictors of
to understand if there is an association mediastinitis. In multivariate analysis, only NLR
between the etiology of DNI and progression and bilateral DNI were significantly associated
to mediastinitis. with progression to mediastinitis. Thus, these
Kimura et al. found in an adjusted analysis that two factors may be the most important clinical
age ≥55 years, NLR ≥13, and CRP ≥30 mg/dL predictors of mediastinitis.
were clinical predictors of mediastinitis , which This study has several limitations. Firstly, since
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further supports our finding of an association this was a retrospective observational study,
between NLR and mediastinitis. NLR reflects there might be bias and limitations in data
the dynamic relationship between the innate collection. For example, there inadequate
and adaptive immune responses and is used data to assess the causes of re-intervention.
as a marker of systemic inflammation . It Furthermore, only a small number of
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is a sensitive and non-specific marker of patients developed complications other
systemic infection, sepsis, and bacteremia, than mediastinitis, which did not allow the
and higher values are associated with worse evaluation of clinical predictors of different
prognosis . It is easy to measure and fast complications. Lastly, some patients with DNI
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responding to inflammatory changes with were treated by stomatology, maxillofacial, or
Volume 61 . Nº4 . Dezembro 2023 373
