Predictive Value of Systemic Inflammatory Indices in Drug Hypersensitivity Severity

Area of Science:

• Immunology
• Allergy and Clinical Immunology
• Hematology

Background:

• Drug hypersensitivity reactions (DHRs) present a spectrum of severity, from mild symptoms to life-threatening anaphylaxis.
• Effective biomarkers are crucial for predicting DHR severity and stratifying patient risk.
• Current diagnostic methods require enhancement for precise risk assessment in drug allergy.

Purpose of the Study:

• To evaluate the predictive capability of Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI).
• To assess these indices measured during a stable period in patients diagnosed with drug allergy.
• To determine the association between baseline inflammatory markers and the severity of DHRs, specifically anaphylaxis.

Main Methods:

• A cohort of 200 patients with DHRs was analyzed, divided into severe (anaphylaxis, n=67) and non-severe (n=133) groups.
• Hemogram parameters for SII, SIRI, and AISI were collected at least one month post-acute symptom resolution to ensure a stable inflammatory state.
• Diagnostic performance was evaluated using age- and sex-adjusted logistic regression and Receiver Operating Characteristic (ROC) analysis.

Main Results:

• All three indices (SII, SIRI, AISI) were significantly elevated in the severe anaphylaxis group compared to the non-severe group (p<0.012).
• Each index independently predicted anaphylaxis risk per standard deviation increase in age- and sex-adjusted models (ORs ranging from 1.46 to 1.55).
• Optimized thresholds indicated that AISI ≥197 (aOR 4.11), SII ≥333 (aOR 3.56), and SIRI ≥1.37 (aOR 3.11) were significantly associated with higher odds of anaphylaxis.

Conclusions:

• Systemic inflammatory indices (SII, SIRI, AISI) are independently linked to anaphylaxis severity in immediate-type DHRs.
• These indices exhibit modest discriminatory performance (AUC 0.61-0.64), suggesting their utility as adjunctive screening tools, not standalone diagnostics.
• Elevated indices during stable periods may indicate a chronic pro-inflammatory state predisposing to severe reactions, warranting further prospective validation.