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Evaluation of systemic immune-inflammation index efficacy in predicting complicated appendicitis in pediatric
Aysun Tekeli1, Mehmet Bahadır Çalışkan2, Gökhan Berktuğ Bahadır2
1Department of Pediatric Emergency Medicine, University of Health Sciences Gülhane Training and Research Hospital, Ankara-Türkiye.
Insights
The systemic immune-inflammation index (SII) and C-reactive protein (CRP) can help predict complicated appendicitis in children. These markers, along with clinical evaluation, improve diagnosis but are not sufficient alone.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Clinical Pathology
Background:
- Acute appendicitis (AA) is a common cause of pediatric emergency department visits for abdominal pain.
- Distinguishing complicated appendicitis (CA) from non-complicated appendicitis (NCA) is crucial for appropriate management.
- Predictive biomarkers for CA in children are needed to guide clinical decisions.
Purpose of the Study:
- To evaluate the diagnostic utility of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients.
- To compare the efficacy of SII and other inflammatory markers in differentiating CA from NCA.
- To identify the most effective biomarkers for predicting CA in pediatric appendicitis.
Main Methods:
- Retrospective analysis of pediatric patients diagnosed with AA.
- Categorization of patients into non-complicated appendicitis (NCA) and complicated appendicitis (CA) groups.
- Measurement and comparison of inflammatory markers including C-reactive protein (CRP), white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and SII.
Main Results:
- The study included 1072 AA patients (74.3% NCA, 25.7% CA) and 541 controls.
- Elevated levels of CRP, WBC, NLR, PLR, and SII were observed in the CA group compared to the NCA group.
- The SII value was significantly higher in the CA group (3132.59±2658.73) than in the NCA group (2164.91±1831.24) (P<0.001).
- Area under the curve analysis identified CRP and SII as the most effective biomarkers for predicting CA.
Conclusions:
- Inflammatory markers, including CRP and SII, show promise in distinguishing between NCA and CA in pediatric patients.
- While valuable, these markers alone are insufficient for definitive CA prediction.
- CRP and SII are identified as the leading biomarkers for predicting CA in pediatric appendicitis cases.
Background:
Acute appendicitis (AA) is one of the most important causes of acute abdominal pain in children who are admitted to the pediatric emergency department. This study aims to determine the usefulness of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients.
Methods:
The patients who underwent surgery with the diagnosis of AA were evaluated retrospectively. AA and control groups were formed. AA was divided into noncomplicated and CA groups. C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelet (PLT)/lymphocyte ratio (PLR), and SII values were recorded. The SII was calculated with the formula of PLT count × neutrophil/lymphocyte. The efficacy of biomarkers in predicting CA was compared.
Results:
Our study included 1072 AA and 541 control patients. There were 74.3% of patients in the non-CA (NCA) group and 25.7% in the CA group. CRP, WBC count, ANC, NLR, PLR when AA and control group, complicated and NCA groups are compared in terms of laboratory parameters and SII level AA and it was higher in the CA group. While the SII value was 2164.91±1831.24 in the patients with NCA and 3132.59±2658.73 in those with CA (P<0.001). When the cut-off values were determined according to the area under the curve, CRP and SII were found to be the best biomarkers in predicting CA.
Conclusion:
Inflammation markers together with clinical evaluation may be useful in distinguishing noncomplicated and complicated AA. However, these parameters alone are not sufficient to predict CA. CRP and SII are the best predictors of CA in pediatric patients.
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