C-reactive protein and neutrophil-to-lymphocyte ratio as key inflammatory indicators in the diagnosis of cervical necrotizing fasciitis

Abstract

Background

Cervical necrotizing fasciitis (CNF) is a life-threatening bacterial infection with a diagnostic challenge. Currently, there is insufficient evidence on the diagnostic accuracy of inflammatory indicators in CNF.

Objective

This study aims to identify key inflammatory indicators and assess their diagnostic accuracy for CNF.

Methods

A diagnostic case-control study was conducted at a tertiary healthcare facility from January 2020 to December 2023. Laboratory data from patients with CNF and non-CNF at admission were evaluated. Key inflammatory indicators were identified through consistent outcomes from multivariable logistic regression and receiver operating characteristic curves analyses. The diagnostic accuracy of these indicators, with the results of combined tests, were calculated.

Results

CNF was confirmed in 21 of the 67 patients investigated. C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) were identified as key inflammatory indicators, with sensitivities of 0.905 and 0.810, and specificities of 0.870 and 0.913, respectively, at CRP threshold of 165.0 mg/L and NLR of 15.8. Combining CRP and NLR in parallel and serial tests increased sensitivity to 0.952 and specificity to 1.0, respectively.

Conclusions and significance

CRP and NLR have been verified as key inflammatory indicators with satisfactory diagnostic abilities for CNF diagnosis, providing a strong foundation for future studies.

Chinese Abstract

背景

颈部坏死性筋膜炎 (CNF) 是一种危及生命的细菌感染, 诊断难度较大。目前, 关于 CNF 炎症指标诊断准确性的证据不足。

目的

本研究旨在确定关键炎症指标并评估其对 CNF 诊断的准确性。

方法

2020 年 1 月至 2023 年 12 月在一家三级医疗机构进行了一项诊断性病例对照研究。评估了 CNF 和非 CNF 患者入院时的实验室数据。通过多变量逻辑回归和受试者操作特征曲线分析的一致结果确定了关键炎症指标。计算了这些指标的诊断准确性以及综合测试的结果。

结果

在接受调查的 67 名患者中, 有 21 名确诊为 CNF。 C反应蛋白(CRP)和中性粒细胞与淋巴细胞比率(NLR)被确定为关键炎症指标, 在CRP阈值为165.0mg / L和NLR为15.8时, 其敏感性分别为0.905和0.810, 特异性分别为0.870和0.913。将CRP和NLR结合进行并行和串行测试, 可分别将敏感性提高至0.952和特异性提高至1.0。

结论和意义

CRP和NLR已被证实为关键炎症指标, 对CNF诊断具有令人满意的诊断力。这为未来的研究提供了坚实的基础。

Keywords:

• Fasciitis
• necrotizing
• bacterial infections
• diagnostic test
• sensitivity and specificity
• C-reactive protein
• neutrophils
• lymphocytes
• case-control study

Acknowledgements

We wish to extend our appreciation to our colleagues for their diligent attention to the participants of the study. Our thanks are also extended to Ms. Wang Cui for her technical assistance in managing the microbiological data.

Disclosure statement

The authors report there are no conflicts of interest to declare.