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Associations Between Complete Blood Count-Derived Inflammation Indices and Emergence Delirium in Children Undergoing
Serkan Altıparmak1, Ayhan Kars1, Sara Salcan2
1Department of Otorhinolaryngology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey.
Insights
Systemic inflammation markers, systemic immune inflammation index (SII) and pan-immune inflammation value (PIV), are associated with pediatric emergence delirium (ED) after adenotonsillectomy. These findings suggest inflammation plays a role in ED development.
Area of Science:
- Pediatric Anesthesiology
- Inflammation Biomarkers
- Postoperative Complications
Background:
- Emergence delirium (ED) is a frequent postoperative issue in children.
- Inflammation is suspected to contribute to ED development, though its exact role is unclear.
Purpose of the Study:
- To examine the relationship between preoperative inflammatory markers (SII and PIV) and ED in pediatric patients undergoing adenoidectomy or adenotonsillectomy.
- To assess the predictive value of SII and PIV for ED development.
Main Methods:
- Prospective study of 3-12-year-old children undergoing adenoidectomy/adenotonsillectomy.
- Calculation of preoperative inflammatory indices (SII, PIV, NLR, NMR, MLR, PLR, PMR) from complete blood counts.
- Assessment of ED using the Pediatric Anesthesia Emergence Delirium (PAED) scale, with the FLACC scale used to control for pain.
Main Results:
- ED occurred in 32.3% of 99 patients.
- Systemic immune inflammation index (SII) and pan-immune inflammation value (PIV) showed significant predictive value for ED (AUC 0.850 and 0.883, respectively).
- Operative time, SII, and PIV were independently associated with ED in multivariable analysis.
Conclusions:
- Preoperative SII and PIV, derived from routine blood tests, are associated with ED in pediatric patients.
- These inflammatory markers may offer insights into the systemic inflammation's role in ED pathophysiology.
Background:
Emergence delirium (ED) is a common postoperative complication in the pediatric population. Although the pathophysiology of ED has not been fully elucidated, an association has been suggested between inflammation and the development of the condition.
Aims:
The aim of this study was to investigate the associations between the development of ED and preoperative inflammatory indices, primarily the systemic immune inflammation index (SII) and the pan-immune inflammation value (PIV) calculated from complete blood count parameters in pediatric patients undergoing adenoidectomy or adenotonsillectomy.
Methods:
This prospective study was conducted with children aged 3-12 years who underwent adenoidectomy or adenotonsillectomy at our hospital. Preoperative inflammatory indices were calculated from complete blood count parameters, including the SII (platelet × neutrophil/lymphocyte), PIV (platelet × neutrophil × monocyte/lymphocyte), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and platelet-to-monocyte ratio (PMR). ED was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale, while the Face, Legs, Activity, Cry, Consolability (FLACC) scale was used to minimize confounding by postoperative pain. Statistical analyses included receiver operating characteristic (ROC) curve analysis and multivariable logistic regression to assess the association between inflammatory indices and emergence delirium.
Results:
ED occurred in 32 out of 99 patients (32.3%). SII exhibited an AUC of 0.850 with a cut-off value of 412 (sensitivity 81.3%; specificity 86.6%). PIV exhibited an area under the curve of 0.883, with a cut-off value of 289 (sensitivity 75.0%; specificity 92.5%). In the univariable analysis, operative time, SII, and PIV were significantly associated with ED. In the multivariable analysis, operative time, SII and PIV were significantly associated with ED.
Conclusions:
SII and PIV values derived from routine complete blood count parameters were observed to be associated with the development of ED in pediatric patients undergoing adenotonsillectomy and may provide useful insights into the potential role of systemic inflammation in the pathophysiology of such delirium.
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