# The Role of qSOFA, Derived Neutrophil-to-Lymphocyte Ratio, MEWS, and PIRO Scores in Predicting the Severity of Odontogenic Infections in Young and Adult Patients

## TL;DR

This study evaluates how well four clinical scores predict the severity of tooth-related infections in patients, finding that the PIRO score is the most accurate.

## Contribution

The study introduces the evaluation of PIRO, qSOFA, dNLR, and MEWS scores for predicting odontogenic infection severity, highlighting PIRO's superior predictive accuracy.

## Key findings

- PIRO score showed the highest predictive accuracy (AUC = 0.912) for severe odontogenic infections.
- qSOFA, dNLR, and MEWS scores also significantly differentiated between severe and mild infections.
- No significant difference in infection severity was found between young and adult patients.

## Abstract

Background and Objectives: Odontogenic infections (OIs) can lead to severe complications if not promptly diagnosed and treated. The Quick Sequential Organ Failure Assessment (qSOFA), derived Neutrophil-to-Lymphocyte Ratio (dNLR); Modified Early Warning Score (MEWS); and Predisposition, Infection, Response, and Organ Dysfunction (PIRO) scores are clinical tools used to predict the severity and outcomes in various infections. This study aims to evaluate the efficacy of these scores in predicting the severity of OIs in adult patients. Methods: A retrospective cohort study was conducted on 120 patients hospitalized for OIs, divided into two groups based on infection severity, using the Symptom Severity (SS) scale. The qSOFA, dNLR, MEWS, and PIRO scores were calculated upon admission. Statistical analyses were performed to assess the predictive value of these scores for severe OIs. Results: Patients with severe OIs (Group B) had significantly higher qSOFA, dNLR, MEWS, and PIRO scores compared to those with lower severity (Group A). The median qSOFA score was 2.00 in Group B versus 0.85 in Group A. No significant difference was observed between young patients and adults in terms of severity. ROC curve analysis showed that the PIRO score had the highest predictive value for severe OI (AUC = 0.912), followed by MEWS (AUC = 0.878), qSOFA (AUC = 0.845), and dNLR (AUC = 0.812). Multivariate logistic regression indicated that the PIRO score was an independent predictor of severe OI (OR = 8.45, 95% CI: 4.12–12.78). Conclusions: The qSOFA, dNLR, MEWS, and PIRO scores are valuable tools for predicting the severity of OIs. Among them, the PIRO score demonstrated the highest predictive accuracy and may be incorporated into clinical practice for early identification of high-risk patients.