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. 2023 Mar;44(3):647-655.
doi: 10.1007/s00246-022-02988-9. Epub 2022 Aug 19.

A Novel Marker for Predicting Fulminant Myocarditis: Systemic Immune-Inflammation Index

Raziye Merve Yaradilmiş  1 , Muhammed Mustafa Güneylioğlu  2 , Betül Öztürk  2 , Aytaç Göktuğ  2 , Orkun Aydın  2 , Ali Güngör  2 , İlknur Bodur  2 , Özkan Kaya  3 , Utku Arman Örün  3 , Can Demir Karacan  2 , Nilden Tuygun  2
Affiliations

A Novel Marker for Predicting Fulminant Myocarditis: Systemic Immune-Inflammation Index

Raziye Merve Yaradilmiş et al. Pediatr Cardiol. 2023 Mar.

Abstract

In myocarditis, the search for effective and appropriate prognostic biomarkers can help clinicians identify high-risk patients in a timely manner and make better medical decisions in clinical practice. The prognostic value of systemic immune-inflammatory index (SII), an innovate biomarker of inflammation, in fulminant myocarditis in children has not been assessed. This study aims to (1) determine the effect of SII and other inflammatory markers on the prognosis of patients with myocarditis, and (2) characterize other factors affecting adverse outcomes in myocarditis. All patients aged between 1 months and 18 years who admitted to Pediatric Emergency Department between January 1, 2015 and October 1, 2021 and were diagnosed with myocarditis were retrospectively analyzed. 106 Eligible subjects were enrolled (67% male, 12.5 years (IQR 6-16). Fulminant myocarditis developed in 16 (15%) of the patients. The median SII was 1927 (1147.75-3610.25) in the fulminant myocarditis group and 351 (251.75-531.25) in the non-fulminant group (p < 0.001). In estimation of fulminant myocarditis, AUC was 0.87 for WBC [95% confidence interval (CI) 0.72-1.00, p = 0.002], 0.94 for ANC (95% CI 0.85-1.00), p = 0.000), 0.92 for SII (95% CI 0.82-1.00, p = 0.000). Spearman's correlation analysis showed a significant negative correlation between SII and LVEF (r = 0.576, p < 0.001). The highest AUC values were associated with ANC, SII, and WBC levels to predict fulminant myocarditis. SII, a readily available biomarker from routine blood parameters, allows early recognition of negative outcomes and can independently predict the prognosis of myocarditis in children.

Keywords: Children; Fulminant myocarditis; Prognosis; Systemic immune–inflammatory index.

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Conflict of interest statement

The authors have no conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of patients. *Patients with inflammatory diseases, autoimmune disease including systemic lupus erythematosus, cancer, leukemia, or any other blood system disease
Fig. 2
Fig. 2
ROC curves of inflammation markers to predict fulminant myocarditis. WBC white blood cell count, ANC absolute neutrophil count, SII systemic immune-inflammation index, ESR erythrocyte sedimentation rate, IG immature granulocytes
See this image and copyright information in PMC

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