关键词: 颈深部脓肿, 预后评估, 评分量表, 风险分层, 个体化治疗

Abstract: Objective To investigate the factors associated with the prognosis of patients with deep neck abscesses and to develop a prognostic scoring system based on these factors. Methods We conducted a retrospective analysis of clinical data from 129 patients with deep neck abscesses to examine the relationship between relevant factors-including major clinical characteristics, laboratory parameters, and imaging findings-and poor clinical outcomes. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for poor prognosis.The optimal cutoff value for continuous variables was determined using receiver operating characteristic(ROC)curves, and these variables were then converted into categorical variables. A simple prognostic scoring system was developed by standardizing and rounding the regression coefficients(B values)of each independent predictor in the multivariate regression model, using the minimum absolute B value as the reference.The model was internally validated using 5-fold cross-validation. The model's discriminatory performance was further evaluated using ROC curves and the area under the curve(AUC), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different risk groups; the Hosmer-Lemeshow test was used to assess model calibration. Results Multivariate logistic regression analysis showed that mediastinal involvement(OR=15.715, 95%CI: 4.847-50.952, P<0.001), APTT≥33.3 s(OR=7.138, 95%CI: 1.143-44.589, P=0.036), and CAR≥3.8(OR=15.422, 95%CI: 4.834-49.206, P<0.001)were independent risk factors for poor prognosis in patients with deep neck abscesses.A simple scoring scale was developed based on the above three factors, with each factor assigned a score of 1, resulting in a total score ranging from 0 to 3. Based on ROC curve analysis, a total score of ≥2 was defined as the high-risk group, and a total score of <2 as the low-risk group. The AUC of this scoring system for predicting adverse outcomes in patients was 0.925(95%CI: 0.878-0.972, P<0.001), with a sensitivity of 96.6%, a specificity of 69.1%, a positive predictive value of 73.1%, a negative predictive value of 95.9%, and an accuracy of 81.8%. The Hosmer-Lemeshow test indicated that the model fit well(χ2=1.291, P=0.863). Conclusion The scoring scale developed in this study is of some value for assessing the prognosis of patients with deep neck abscesses and can help optimize individualized treatment decisions for this condition.

Key words: Deep Neck Space Abscess, Prognostic assessment, Scoring scale, Risk stratification, Individualized treatment