Common laboratory tests and their correlation with the clinical presentation and prognosis of Lemierre syndrome

Abstract

Introduction: Lemierre syndrome is a thromboembolic complication following an acute bacterial infection of the head/neck area, often due to anaerobes. Data on the prognostic role of laboratory parameters is lacking.

Methods: We analyzed individual-patient level data from a multinational cohort of patients with Lemierre-syndrome. Patients had an infection in the head/neck area, and contiguous vein thrombosis or septic embolism, irrespective of the causal pathogen. We studied the patterns of white blood cell count, platelet count, and C-reactive protein concentration investigating their association with baseline characteristics and in-hospital clinical outcomes (septic embolism, major bleeding, all-cause death).

Results: A total of 447 (63%) patients had complete data for analysis. White blood cells were elevated across all subgroups (median 17 × 10³/μL; Q1-Q3:12-21). Median platelet count was 61 × 10³/μL (Q1-Q3:30-108) with decreasing levels with increasing age. Males, patients with renal failure or cardiopulmonary impairment, and those with typical Lemierre syndrome (tonsillitis, septic thromboembolism, positivity for Fusobacterium spp.) had the lowest platelet count. Median C-reactive protein was 122 (Q1-Q3:27-248) mg/L with higher values in patients who also had more severe thrombocytopenia. The overall risk of complications was similar across subgroups of patients stratified according to white blood cell and C-reactive protein levels. Patients in the lowest third of platelet count (<42 × 10³/μL) had the highest rate of complications (26%), as opposed to those in the highest third (11%), notably septic embolic events.

Conclusions: Common laboratory tests correlate with the clinical presentation of Lemierre syndrome. However, extreme values did not appear to be prognostically relevant for in-hospital complications and potentially able to improve clinical management.

Keywords: Biomarkers; C-reactive protein; Lemierre syndrome; Platelets; Septic embolism; White blood cells.