The Usefulness of Serum Procalcitonin in Determining the Severity of Spreading Odontogenic Infections in Patients Seen at Ile-Ife, Nigeria

Abstract

Background:The high morbidity, mortality and cost of treatment of spreading odontogenic infections makes it critical to find diagnostic tools that can facilitate prompt and accurate management decision-making. Materials and methods:This is a prospective cohort study of 63 patients being managed for spreading odontogenic infection at the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria. Serum procalcitonin levels were recorded at three time points: At presentation, day-four and day-eight after treatment has commenced. The severity of spreading odontogenic infections was determined using the criteria described by Flynn, et al. A Mann-Whitney U test was used to compare the serum procalcitonin at different time points. A Receiver Operating Characteristic (ROC) curve was plotted to determine the diagnostic accuracy. The sensitivity, specificity, negative predictive value, positive predictive value, positive likelihood ratio and negative likelihood ratio of serum-procalcitonin as a diagnostic tool for spreading odontogenic infections were calculated. Results:Serum procalcitonin levels at presentation ranged from 51.8 pg/ml to 484.3 pg/ml with a mean value of 169.9 ± 108.0 pg/ml and median (interquartile range) value of 129.3 (81.5) pg/ml. There was an increase in serum procalcitonin level with increased severity of odontogenic infections, the relationship was statistically significant (H = 40.665, df = 2, p = < 0.001). The diagnostic accuracy of serum procalcitonin was 0.60 (95% CI = 0.40-0.77 ; p = 0.33) at a cut-off point of 168.3 pg/ml. Serum procalcitonin had moderate sensitivity (53.3%) and specificity (75.0%), high negative predictive value (83.7%), low positive predictive value (40.0%), a 1.6 positive likelihood ratio and a 0.5 negative likelihood ratio. Conclusion:There was a significant increase in serum procalcitonin level with increased severity of odontogenic infections. Thus, serum procalcitonin could differentiate between low to moderate severe and high severe spreading odontogenic infections. It can be used as an adjunct to traditional clinical methods of determining severity of spreading odontogenic infections.