Procalcitonin as a predictor of length of stay in patients with odontogenic infections

Abstract

OBJECTIVES: Our study aimed to evaluate procalcitonin (PCT) as a prognostic marker in advanced odontogenic infections. In addition, we sought to identify further prognostic markers that could be used to predict the length of hospital stay (LOS). MATERIALS AND METHODS: We retrospectively analysed 61 patients who were hospitalised between January and August 2020 for surgical abscess drainage in the Department of Oral and Maxillofacial Surgery at the University Hospital of Bonn. Univariable logistic discrete hazard models were used to assess the association between baseline levels as well as temporal changes in laboratory parameters (PCT, C-reactive protein (CRP), and leukocytes) and LOS. In addition, a tree-based approach for modelling discrete time-to-event data was used to identify risk groups of patients with a prolonged LOS. RESULTS: Median LOS were 5, 7, and 9 days for different PCT concentrations < 0.1 µg/l, 0.1-0.5 µg/l, and > 0.5 µg/l, respectively (p < 0.001). The data-driven tree identified three subgroups with median LOS of 4, 6, and 10 days based on preoperative CRP and PCT levels. Patients with CRP > 153 mg/l had a median LOS of 10 days, while those with CRP ≤ 153 mg/l had median LOS of 6 or 4 days depending on whether PCT was > 0.03 µg/l or ≤ 0.03 µg/l. CONCLUSIONS: PCT may serve as a useful prognostic marker for estimating LOS, even in severe odontogenic infections. Exploratory decision tree analysis demonstrated that the combined assessment of PCT and CRP levels could help stratify patients into distinct LOS subgroups, which may facilitate clinical decision-making and more accurate estimation of treatment outcomes.