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Diagnostic Value of the Systemic Immune-Inflammation Index in Differentiating Acute Appendicitis From Familial

Ceyhan Şahin1, Eray Tunce2, Cengiz Gül1

  • 1Department of Pediatric Surgery.

Pediatric Emergency Care
|February 12, 2026
PubMed

Insights

The systemic immune-inflammation index (SII) can help differentiate acute appendicitis from Familial Mediterranean Fever attacks in children. Combining SII with other blood markers may improve diagnosis for acute abdominal pain.

Area of Science:

  • Pediatric Surgery
  • Pediatric Gastroenterology
  • Hematology

Background:

  • Acute abdominal pain in children is frequently caused by acute appendicitis and Familial Mediterranean Fever (FMF) attacks.
  • These conditions often share overlapping clinical presentations, complicating diagnosis.
  • Accurate differentiation is crucial for appropriate management and preventing complications.

Purpose of the Study:

  • To evaluate the diagnostic utility of the systemic immune-inflammation index (SII) in distinguishing between acute appendicitis and FMF attacks in pediatric patients.
  • To assess if combining the SII with other hematological parameters enhances diagnostic discrimination.

Main Methods:

  • A retrospective diagnostic accuracy study included 90 pediatric patients (1-18 years) with confirmed acute appendicitis or clinically defined FMF attacks.
  • Complete blood count parameters were analyzed to calculate SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).
  • Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance, including a combined hematological model.

Main Results:

  • Patients with acute appendicitis (n=44) had significantly higher median SII values compared to those with FMF attacks (n=46).
  • The neutrophil-to-lymphocyte ratio (NLR) was also significantly higher in the acute appendicitis group.
  • A combined hematological model demonstrated superior discriminative performance over the SII alone.

Conclusions:

  • The systemic immune-inflammation index (SII) is significantly elevated in pediatric acute appendicitis versus FMF attacks, showing good diagnostic utility.
  • Combining hematological indices like SII may improve diagnostic accuracy for acute abdominal pain in children.
  • These markers can serve as supportive tools in the differential diagnosis of pediatric acute abdominal pain.
Abstract

Keywords:
acute appendicitisdiagnostic biomarkersfamilial Mediterranean feverpediatric abdominal painsystemic immune-inflammation index

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