TITLE:
Neutrophil to Lymphocyte Ratio as a Predictor of Outcomes in Orofacial Infections in Patients Admitted to Kenyatta National Teaching and Referral Hospital in Nairobi, Kenya
AUTHORS:
Nahashon Njeru Maringa, Fawzia Butt, Wambeti Twahir, Elizabeth Anne Okumu Dimba, Shamim Butt
KEYWORDS:
Neutrophil Lymphocyte Ratio, C-Reactive Protein, Orofacial Infections
JOURNAL NAME:
Open Journal of Stomatology,
Vol.16 No.3,
March
12,
2026
ABSTRACT: Background: Untreated and progressive orofacial infections pose a great health risk due to local and distant spread, which often leads to increased morbidity and mortality. These infections can be of either odontogenic or non-odontogenic origin. Early definitive diagnosis allows for early intervention, thereby ultimately reducing the associated morbidity and mortality. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are the most commonly used markers of severity, prognosis and treatment response of severe orofacial infections in our setup. The neutrophil to lymphocyte ratio (NLR) has been demonstrated to be a useful, inexpensive diagnostic and prognostication tool in infections in other parts of the body. Its utility in orofacial infections remains largely unexplored. Aim: To determine the utility of NLR as an independent predictor of outcomes in orofacial infections. Design: This was a cross-sectional study carried out in patients admitted with orofacial infections to the oral & maxillofacial, otorhinolaryngology and ophthalmology clinics at the Kenyatta National Teaching and Referral Hospital (KNH) in Nairobi, Kenya between November 2023 and July 2024. Methods: Demographic and relevant clinical data were obtained from consenting eligible patients at admission. The values of the absolute counts of neutrophils, lymphocytes and C-reactive proteins were also obtained, and the Neutrophil-Lymphocyte Ratio (NLR) calculated. Length of hospital stay, admission to intensive care unit (ICU) and mortality were recorded. The Mann Whitney U test was used to establish whether there was a significant difference in NLR and CRP among outcomes. Spearman rank order correlation was used to establish the relationship between NLR values and length of stay. Results: Only 80 patients were recruited into the study. The participants ranged form 60 year with an interquartile range of 33.8 years and a median age of 26.3 years. Most participants were male (71.2%, n = 57). NLR was significantly associated with the length of hospital stay with a p-value of 0.029 before adjustment. Participants with normal NLR had 8.21 times higher odds of disease resolution compared to those with abnormal. Conclusion: NLR had a significant association with mortality and disease severity and was comparable to CRP in ability to predict disease outcomes in orofacial infections. Participants with resolved disease had significantly lower levels of NLR compared to those who were admitted to the ICU. Similarly, participants who died or were admitted to the ICU had significantly higher levels of CRP compared to those with resolved disease. NLR can be an easily accessible and good predictor of disease outcomes.