Using prealbumin as an inflammatory marker for patients with deep space infections of odontogenic origin

Background: The general health of the host may contribute to the severity of odontogenic infections. An example is the link between protein malnutrition and host defense mechanisms, most notably cell-mediated and mucosal immune responses. The plasma concentration of prealbumin, a protein synthesized in the liver with a half-life of 1.8 days, is an indicator of malnutrition. Materials and Methods: We retrospectively reviewed the medical records of all patients who were admitted to our hospital with a diagnosis of odontogenic infection in 2002 and 2003. We recorded prealbumin concentrations, number of infected spaces (ie, severity of infection), hematocrit, blood urea nitrogen (BUN) concentration, and the results of general blood studies. Results: The median age of the 22 patients included in this study was 33 years (range, 17 to 57 years); 59% were men. The median prealbumin concentration was 12.85 (range, 5.7 to 27.5); the accepted normal level is 19 or higher (81.8% of concentrations were below normal). A Mann-Whitney rank sum test found a statistically significant relationship between prealbumin concentrations and length of hospital stay (P = .038). Logistic regression analysis showed that length of hospital stay was positively related to the number of infected spaces and the BUN concentration and negatively related to prealbumin concentrations. These factors could accurately predict the length of hospital stay for 77% of patients (Fisher exact test; P = .026). Conclusions: Prealbumin levels are significantly lower than normal among patients admitted for treatment of severe odontogenic infection. There appears to be a relationship between length of stay and lower prealbumin concentrations.