A New Biomarker in the Diagnosis of Pediatric Corrosive Esophagitis: Pan-Immune Inflammatory Score and Systemic Inflammatory Index: Can esophagoscopy be omitted in asymptomatic patients?

Objective : In our study, we aimed to investigate the effect on prognosis by evaluating whether there is a relationship between NLR, PLR, SII, SIRI, and PIV levels and symptoms in our patients who ingested corrosive substances. Additionally, we aimed to investigate the feasibility of using biomarkers as an alternative to endoscopy, an invasive procedure, thereby contributing to the development of a rapid and low-cost diagnostic approach in clinical management. Material and Methods: We retrospectively analyzed 213 pediatric cases aged 0-18 years who presented to our hospital with corrosive esophagitis between 2018 and 2023. In the study, demographic data (age and gender) and laboratory parameters were recorded for each patient, and inflammation indices derived from these data, namely SII, SIRI, and PIV indices, were determined. Patients were examined in three groups according to the type of substance they swallowed: detergents, bleach and other corrosive substances, and sink unblockers and limescale removers. Additionally, two subgroups were formed based on the presence of symptoms: symptomatic and asymptomatic. Statistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA, License: Hitit University). Kolmogorov-Smirnov and Shapiro-Wilks tests, histograms, and Q-Q plots were used to assess the normal distribution of numerical data. Variance homogeneity was tested using the Levene test.In our study, neutrophil levels were significantly higher in the symptomatic group (p=0.016), while lymphocyte levels were lower (p=0.007). Consequently, NLR was markedly elevated in the symptomatic group (p=0.002). A sensitivity of 61.1% and a specificity of 90.3% were obtained for NLR. Similarly, PLR (p=0.006), SII (p=0.004), SIRI (p=0.020), and PIV (p=0.019) values were also found to be significantly higher in the symptomatic group. The likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR=6.66; 95% CI: 1.04–42.9; p=0.046). Furthermore, the risk of symptom development in patients with NLR ≥2.15 was significantly higher compared to those with low NLR levels (OR=17.6; 95% CI: 5.6–55.5; p<0.001). Conclusion: Blood parameter values are predicted to be a good indicator of the severity of corrosive esophagitis and may help predict the degree of mortality and morbidity. This prevents unnecessary endoscopies as an invasive method.