The present systematic review was performed to identify risk factors associated with life-threatening complications of head and neck space infections (LCHNSI) within the included studies and assess the magnitude of their impact on patients.

We systematically searched PubMed, Web of Science, EmBase, Scopus and CNKI for articles that reported risk factors associated with life-threatening complications of head and neck space infections from inception to 14 December 2023. Only factors reported in at least three papers were considered in the meta-analysis. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using fixed effects model and random effects model. The between-study heterogeneity of effect size was quantified using the Q statistic and I². In addition, subgroup analysis stratified by study characteristics and sensitivity analysis were performed to explore the potential sources of heterogeneity and the stability of the results.

The review included a total of 29 studies. The results revealed that the risk factors which associated with LCHNSI were included diabetes mellitus (OR = 3.31, 95 % CI: 2.49–4.40), total leukocyte count(≥15 × 10⁹/L) (OR = 1.21, 95 %CI: 1.04–1.42), multiple space involvement (OR = 4.32, 95 %CI: 3.47–5.38), combined systemic diseases (OR = 9.94, 95 %CI: 6.30–15.67), advanced age(≥60) (OR = 3.90, 95 %CI: 2.80–5.44), dyspnoea (OR = 23.39, 95 %CI: 12.41–44.10), high temperature(≥39°C) (OR = 3.23, 95 %CI: 2.02–5.17), retropharyngeal space involvement (OR = 3.62, 95 %CI: 2.06–6.35), parapharyngeal space involvement (OR = 4.62, 95 %CI: 2.27–9.42).

According to the current analysis, diabetes mellitus, total leukocyte count(≥15 × 10⁹/L), combined systemic diseases, multiple space involvement, advanced age(≥60), dyspnoea, high temperature (≥39 °C), retropharyngeal space involvement, parapharyngeal space involvement were the risk factors for LCHNSI. To mitigate the incidence of LCHNSI, clinical staff should carefully manage these risk factors, ensure prompt diagnosis, and implement timely preventive measures.