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Distinguishing Periorbital Necrotizing Fasciitis from Orbital Cellulitis Using Admission Laboratory Values.

Mitchell J Rheeman1, Michael I Rothschild1, Michael J Pokabla1

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Certain complete blood count indices can help differentiate periorbital necrotizing fasciitis (PNF) from orbital cellulitis. Elevated systemic inflammation response index and hemoglobin ratios may indicate PNF, aiding early diagnosis and treatment.

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Area of Science:

  • Ophthalmology
  • Emergency Medicine
  • Hematology

Background:

  • Periorbital necrotizing fasciitis (PNF) is a severe infection requiring prompt differentiation from orbital cellulitis.
  • Accurate early diagnosis is crucial for effective management and preventing vision loss or systemic complications.

Purpose of the Study:

  • To assess the diagnostic utility of seven complete blood count-derived inflammatory markers in distinguishing PNF from orbital cellulitis upon emergency department presentation.
  • To identify specific biomarkers that can aid in the early recognition of PNF.

Main Methods:

  • A retrospective case-control study involving adult patients diagnosed with PNF or orbital cellulitis.
  • Calculation of seven inflammatory indices: systemic immune-inflammatory response index, systemic immune-inflammation index, systemic inflammation response index, platelet-to-lymphocyte ratio, platelet-to-monocyte ratio, hemoglobin-to-platelet ratio, and hemoglobin-to-lymphocyte ratio.
  • Statistical analysis using Mann-Whitney tests and receiver operating characteristic (ROC) curve analysis.

Main Results:

  • Twenty-two PNF and 18 orbital cellulitis patients were analyzed.
  • Systemic immune-inflammation index, systemic inflammation response index, hemoglobin-to-platelet ratio, and hemoglobin-to-lymphocyte ratio were significantly elevated in the PNF group (p < 0.05).
  • ROC analysis showed moderate discriminatory power for these indices (AUC 0.6970–0.7374).

Conclusions:

  • Systemic immune-inflammation index, systemic inflammation response index, hemoglobin-to-platelet ratio, and hemoglobin-to-lymphocyte ratio show potential as accessible biomarkers for differentiating PNF from orbital cellulitis.
  • These markers, when used with clinical and radiographic data, may facilitate earlier PNF diagnosis and timely intervention.
  • Prompt management guided by these biomarkers can reduce morbidity and preserve vision.