Utility of the systemic immune-inflammation index to predict serious bacterial infections in infants with fever without a source.

ABSTRACT

INTRODUCTION: This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS). METHODS: Infants (aged 1-4 months) evaluated in the pediatric emergency department for FWS were divided into two groups with SBI and without SBI. The efficacy of inflammatory markers in predicting SBI was compared. RESULTS: The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p < 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p < 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI) 0.85-0.94] for C-reactive protein (CRP), 0.86 (95% CI 0.81-0.91) for absolute neutrophil count (ANC), 0.84 (95% CI 0.78-0.89) for the SII, and 0.81 (95% CI 0.74-0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p < 0.001 and p = 0.008, respectively). CONCLUSION: We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection.