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Utility of systemic immune-inflammation index as a serum biomarker to differentiate between complicated and simple
Nikhil Rajvanshi1, Prawin Kumar1, Jagdish Prasad Goyal1
1Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Insights
The systemic immune-inflammation index (SII) can help distinguish between simple and complicated para-pneumonic effusion (PPE) in children. Higher SII levels indicate complicated PPE, aiding in early diagnosis and treatment.
Area of Science:
- Pediatric Pulmonology
- Inflammatory Biomarkers
- Diagnostic Accuracy
Background:
- Para-pneumonic effusion (PPE) is a common complication of pneumonia in children.
- Differentiating simple from complicated PPE is crucial for appropriate management.
- Novel inflammatory biomarkers require evaluation for clinical utility.
Purpose of the Study:
- To assess the efficacy of the systemic immune-inflammation index (SII) in differentiating simple and complicated PPE in pediatric patients.
- To compare the diagnostic performance of SII with other inflammatory markers.
Main Methods:
- Retrospective analysis of pediatric patients diagnosed with simple or complicated PPE (April 2019 - September 2022).
- Comparison of SII and other biomarkers between simple and complicated PPE groups.
- Receiver operating characteristic (ROC) curve analysis with Youden index to determine discriminative value.
Main Results:
- 50 children were included; 62% had complicated PPE.
- SII was significantly higher in the complicated PPE group (p=0.007).
- SII demonstrated good discriminative value (Area Under Curve = 0.736), comparable to C-reactive protein (AUC = 0.771).
- Optimal SII cut-off of 1557×10³μL achieved 82.4% sensitivity and 57.6% specificity.
Conclusions:
- The systemic immune-inflammation index (SII) shows potential as a screening tool for differentiating complicated from simple PPE in children.
- SII's utility at presentation can guide timely clinical decisions and treatment strategies.
Abstract:
The systemic immune-inflammation index (SII) is a novel inflammatory biomarker. Simple and complicated para-pneumonic effusion (PPE) are two significant complications of pneumonia. We evaluated the efficacy of the SII to differentiate between the two. Records of all children up to 18 years of age admitted between April 2019 and September 2022 and diagnosed with simple or complicated PPE were retrospectively evaluated. SII and other biomarkers were compared between both groups. Receiver operating characteristics with the Youden index were used to estimate the discriminative value of SII. 50 children were enrolled with a median (interquartile range) age of 81.5 (36.7, 133.5) months; 31 (62%) were male. 31 (62%) had complicated PPE, and 19 (38%) had simple PPE. SII was significantly higher in complicated PPE (p=0.007). Good areas under the curve were found for C-reactive protein (0.771) and SII (0.736) to differentiate complicated from simple PPE. The best cut-off value for SII to differentiate complicated PPE from simple PPE was 1557×103μL, with a sensitivity of 82.4% and specificity of 57.6%. SII can be used as a screening tool to differentiate between complicated and simple PPE at the time of presentation.
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