Evaluation of the Systemic Inflammatory Landscape and C1q/TNF-Related Protein Profiles in Facial Paralysis

Background and Objectives: The primary objective of this study was to elucidate the diagnostic significance of systemic inflammatory indices and C1q/TNF-related proteins (CTRP3 and CTRP5) in acute facial paralysis, with a focus on identifying independent metabolic and immunological predictors. Materials and Methods: This retrospective analysis included 64 individuals (25 patients with acute facial paralysis and 39 healthy controls). Complete blood count-derived indices (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]), serum albumin, and serum CTRP3/CTRP5 levels (ELISA) were compared between groups. Independent predictors were assessed using binary logistic regression, and discriminative performance was evaluated by ROC analysis. Results: Compared with controls, the facial paralysis group showed lower albumin (p < 0.001) and lymphocyte counts (p = 0.010), higher neutrophil counts (p = 0.012), and elevated NLR (p < 0.001) and PLR (p = 0.026). CTRP3 levels were significantly lower in patients (p = 0.002), whereas CTRP5 did not differ between groups (p = 0.853). In a parsimonious multivariable logistic regression model adjusted for NLR and CTRP3, NLR remained the only independent predictor (OR = 2.54, p = 0.004). ROC analysis showed an AUC of 0.753 for NLR and a raw AUC of 0.265 for CTRP3 (p = 0.002). An AUC significantly below 0.5 indicates that lower CTRP3 levels are associated with facial paralysis, which is statistically equivalent to an inverse predictor. Conclusions: Acute facial paralysis is characterized by a systemic inflammatory shift and reduced CTRP3 levels. Given the modest sample size, these findings should be strictly considered hypothesis-generating, suggesting that the depletion of anti-inflammatory defenses and increased inflammatory burden may play a role in the acute phase.