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PAN-Immune inflammation value: a new biomarker for diagnosing appendicitis in children??
Nurcan Çoşkun1, Mehmet Metin2, Gül Doğan2
1Department of Pediatric Surgery, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey. nurcanerguncoskun19@gmail.com.
Insights
The pan-immune-inflammation values (PIV) index shows potential for diagnosing pediatric appendicitis but requires further validation. PIV may aid diagnosis when used with other clinical and radiological data.
Area of Science:
- Pediatric Surgery
- Biomarker Discovery
- Inflammatory Markers
Background:
- Acute appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to prevent complications.
- Novel biomarkers are needed to improve diagnostic accuracy.
Purpose of the Study:
- To evaluate the pan-immune-inflammation values (PIV) index as a diagnostic biomarker for pediatric appendicitis.
- To compare the performance of PIV with other systemic inflammatory indices.
Main Methods:
- Retrospective analysis of 1,514 pediatric patients (0-18 years) with abdominal pain.
- Calculation of PIV, Systemic Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR).
- Receiver Operating Characteristic (ROC) and multiple logistic regression (MLR) analyses were performed.
Main Results:
- PIV showed potential, with an optimal cut-off of 919.3 yielding 72.2% sensitivity and 54.1% specificity.
- In MLR, PIV > 919.3 increased appendicitis likelihood 2.67-fold.
- Other markers like CRP and PLR demonstrated weak predictive value.
Conclusions:
- PIV shows promise as a novel biomarker for pediatric appendicitis.
- Diagnostic utility is limited without supplementary clinical and radiological data.
- Larger prospective studies are recommended for validation.
Background:
This study investigates the potential of the pan-immune-inflammation values (PIV) index as a biomarker for diagnosing acute appendicitis in children and compares its performance with other systemic inflammatory markers.
Methods:
A retrospective analysis of 1,514 pediatric patients aged 0-18 years with abdominal pain admitted between 2019 and 2023 was conducted. Patients were categorized into complicated, non-complicated appendicitis, negative appendectomy, and non-surgical treatment groups. Demographic and laboratory data were recorded, and PIV, Systemic Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) indices were calculated. Receiver Operating Characteristic (ROC) analysis was used to assess predictive performance, with optimal cut-offs evaluated for sensitivity, specificity, and multiple logistic regression (MLR) analyses.
Results:
Based on Area Under the Curve (AUC), C-reactive Protein (CRP), lymphocyte, and PLR showed weak predictive value, while White Blood Cell Count (WBC), neutrophil, monocyte, NLR, SII, SIRI, and PIV demonstrated poor predictive value for appendicitis. Optimal cut-offs were 3.40 for NLR, 134.5 for PLR, 1010.3 for SII, 3.47 for SIRI, and 919.3 for PIV, with sensitivity and specificity values of 78.7%, 47.1% for NLR; 64.7%, 47.5% for PLR; 75.6%, 52% for SII; 71.5%, 57.3% for SIRI; and 72.2%, 54.1% for PIV. In the MLR model, PIV above 919.3 increased appendicitis likelihood 2.67-fold (95% Confidence Interval: 2.16-3.37).
Conclusion:
Although PIV demonstrated potential as a novel biomarker for pediatric appendicitis, its diagnostic utility remains limited without supplementary clinical and radiological data. Larger prospective studies are recommended to validate these findings and improve clinical decision-making. PIV may serve as a supplementary tool in diagnosing pediatric appendicitis when used alongside other markers and diagnostic methods.
Trial Registration:
'retrospectively registered'.
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