Predictors of Severe Course in Odontogenic Cervicofacial Infections: A Prospective Multicenter Cohort Study

Background: Odontogenic cervicofacial infections are prevalent and can progress to life-threatening conditions, imposing a substantial burden on both patients and healthcare systems. The present study evaluated the association of presentation delay and comorbidities with clinical severity and healthcare resource utilization. Methods: This prospective multicenter cohort study enrolled patients admitted with odontogenic cervicofacial infection at two university hospitals over a one-year period. Demographic and clinical data were systematically collected. Disease severity at presentation was quantified using the Cervicofacial Infection Severity Index (CFISI), a clinically derived composite index incorporating predefined indicators of airway compromise, systemic involvement, and physiological derangement. Results: A total of 61 patients (median age 45 years; range 4-88) were included. The median time to admission was 4 days (IQR 2-5), and the median number of involved anatomical spaces was two (IQR 1-3). The number of involved spaces was significantly associated with a severe clinical course (OR 1.72, 95% CI 1.13-2.63, and p = 0.011). Secondary space involvement correlated with prolonged hospitalization, with a mean length of stay of 11.5 days (95% CI 7.1-15.9) compared to 5.1 days (95% CI 4.6-5.7) in patients without secondary space involvement (p < 0.00001). CFISI was significantly associated with severe clinical course in both univariable (OR 1.16, 95% CI 1.01-1.26, and p = 0.044) and multivariable analyses (OR 1.20, 95% CI 1.01-1.42, and p = 0.042). Increasing age was also independently associated with severe clinical course (OR 1.04 per year, 95% CI 1.00-1.07, and p = 0.028). No predictor demonstrated a significant association with high healthcare resource utilization. Conclusions: Within this cohort, clinical severity was associated with patient age, infection extent, and CFISI. In contrast, delay in presentation and comorbidities did not predict severe outcomes. Secondary space involvement was linked to prolonged hospitalization. No significant predictors of high healthcare resource utilization were identified.