Evaluation of Systemic Inflammation in Pediatric Rheumatic Diseases Using a Composite Systemic Inflammation Score

Isolated inflammatory markers have been proposed to assess systemic inflammation, but a comprehensive composite measure is still needed. The current study aimed to evaluate systemic inflammation in Pediatric Rheumatic Diseases by developing a biomarker-based composite systemic inflammation score (CSIS).

This prospective observational study enrolled 117 children with rheumatic diseases-systemic-onset juvenile idiopathic arthritis (SOJIA), systemic lupus erythematosus (SLE), IgA vasculitis (IgAV), and Kawasaki disease (KD), along with 50 age, gender and temporal matched healthy controls. Associations between disease groups and inflammatory biomarkers [neutrophil-to-lymphocyte ratio (NLR), platelet count, ESR, CRP, D-dimer, procalcitonin, ferritin, fibrinogen, and albumin] were evaluated. The CSIS was developed using eight validated, routinely available parameters, with a total score ranging from 0 to 16. Prediction accuracy was evaluated with the area under the receiver operating characteristic curve (AUC).

Comparative analysis demonstrated significantly higher levels of inflammatory markers in patients than in controls, including NLR, platelet count, erythrocyte ESR, CRP, D-dimer, ferritin, fibrinogen, and albumin (all p <0.001). These eight significantly associated biomarkers were incorporated into the scoring systems' development. The CSIS was stratified into four categories to reflect the degree of inflammatory burden: 0-2 (no inflammation), >2-7 (mild inflammation), >7-10 (moderate inflammation), and >10 (severe inflammation).

The CSIS can be readily applied to gauge inflammation severity in the clinical setting. Changes in inflammation scores over time can also reflect disease progression or remission, allowing for timely interventions and better outcomes.