Pan-immune-inflammation value and systemic inflammation indices as predictors of disease severity in hidradenitis suppurativa

Year 2026, Volume: 8 Issue: 2, 364 - 371, 10.03.2026

Gökçe Işıl Kurmuş , Erkin Berkay Yılmaz , Selda Pelin Kartal

https://izlik.org/JA82BW56AB

Abstract

Aims: This study aimed to evaluate complete blood count derived inflammatory indices, including the pan-immune-inflammation value (PIV), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), in patients with hidradenitis suppurativa (HS). Additional objectives were to examine their associations with disease severity using Hurley stage and IHS4 and to assess their diagnostic performance and their potential role in identifying severe disease.
Methods: A retrospective analysis was conducted among adults diagnosed with HS controls selected from individuals without inflammatory skin disease. Demographic data, laboratory results, and clinical severity scores were reviewed. PIV, SII, and SIRI were calculated from neutrophil, lymphocyte, monocyte, and platelet counts. Group comparisons, correlation analyses, receiver operating characteristic (ROC) curves, and logistic regression models were used to assess the relationships between inflammatory indices and disease features.
Results: A total of 101 HS patients and 82 controls were included. HS patients showed higher inflammatory activity, with increased neutrophils (5.88 vs 4.12×10³/mm³, p<0.001), platelets (308 vs 205×10³/mm³, p<0.001). CRP levels were higher in HS (8.64 vs. 1.0 mg/L, p<0.001), whereas ESR levels were comparable between groups (11 vs. 8 mm/h, p=0.45). All indices were significantly elevated in HS, including SII (650.2 vs 277.6, p<0.001), SIRI (1.45 vs 0.98, p<0.001), and PIV (479.5 vs 203.2, p<0.001). Each index showed a progressive rise across Hurley stages: PIV increased from 264.28 in stage I to 621.41 in stage III (p<0.01), SII from 445.20 to 819.73 (p<0.01), and SIRI from 1.10 to 1.65 (p<0.05). All indices correlated positively with IHS4, with the strongest correlations observed for SII (r=0.444, p<0.001) and PIV (r=0.433, p<0.001). ROC analysis showed high diagnostic performance for CRP (AUC 0.94), followed by SII (AUC 0.91) and PIV (AUC 0.84; specificity 92.7%). In multivariable logistic regression analyses adjusted for age, sex, BMI, and smoking status, higher SII and PIV values were independently associated with severe HS.
Conclusion: SII showed a consistent association with severe disease, while PIV showed an increase with disease severity and demonstrated a modest independent association. Overall, these indices appear to support clinical evaluation rather than replace it. Larger prospective studies are needed to determine their value in long-term monitoring and treatment response.

Keywords

Hidradenitis suppurativa , pan-immune-inflammation value , systemic inflammation response index , systemic immune inflammation index , disease severity

Hidradenitis suppurativa’da hastalık şiddetinin değerlendirilmesinde pan-immün-inflamasyon değeri ve sistemik inflamasyon indeksleri

https://izlik.org/JA82BW56AB

Abstract

Amaç: Bu çalışmada, hidradenitis suppurativa (HS) hastalarında pan-immün-inflamasyon değeri (PIV), sistemik immün inflamasyon indeksi (SII) ve sistemik inflamasyon yanıt indeksi (SIRI) dahil olmak üzere tam kan sayımından türetilen inflamatuvar indeksleri değerlendirmek amaçlanmıştır. Ek amaçlar arasında bu indekslerin Hurley evresi ve IHS4 ile hastalık şiddeti arasındaki ilişkilerini incelemek, tanısal performanslarını değerlendirmek ve şiddetli hastalığın belirlenmesindeki potansiyel rollerini araştırmak yer almaktadır.
Yöntemler: İnflamatuvar deri hastalığı bulunmayan, yaş ve cinsiyet açısından eşleştirilmiş kontroller ile HS tanısı alan yetişkin hastalar arasında retrospektif bir analiz gerçekleştirildi. Demografik veriler, laboratuvar sonuçları ve klinik şiddet skorları değerlendirildi. PIV, SII ve SIRI; nötrofil, lenfosit, monosit ve trombosit sayılarından hesaplandı. İnflamatuvar indeksler ile hastalık özellikleri arasındaki ilişkileri değerlendirmek için grup karşılaştırmaları, korelasyon analizleri, ROC eğrileri ve lojistik regresyon modelleri uygulandı.
Bulgular: Çalışmaya 101 HS hastası ve 82 kontrol dahil edildi. HS hastalarında inflamatuvar aktivitenin daha yüksek olduğu görüldü; nötrofiller (5.88’e karşı 4.12 ×10³/mm³, p < 0.001), trombositler (308’e karşı 205 ×10³/mm³, p < 0.001), CRP (8.64’e karşı 1.0 mg/L) ve ESR (11’e karşı 8 mm/sa) belirgin şekilde yüksekti. Tüm indeksler HS grubunda anlamlı olarak artmıştı; SII (650.2’ye karşı 277.6, p < 0.001), SIRI (1.45’e karşı 0.98, p < 0.001) ve PIV (479.5’e karşı 203.2, p < 0.001). Her indeks Hurley evreleri boyunca kademeli bir yükseliş gösterdi: PIV evre I’de 264.28’den evre III’te 621.41’e (p < 0.01), SII 445.20’den 819.73’e (p < 0.01) ve SIRI 1.10’dan 1.65’e (p < 0.05) yükseldi. Tüm indeksler IHS4 ile pozitif korelasyon gösterdi; en güçlü ilişkiler SII (r = 0.444, p < 0.001) ve PIV (r = 0.433, p < 0.001) için saptandı. ROC analizi, SII için iyi tanısal performans (AUC 0.91) ve PIV için yüksek özgüllükle birlikte iyi performans (AUC 0.84; özgüllük yüzde 92.7) gösterdi. Lojistik regresyonda SII, Hurley evre III’ün tek bağımsız belirleyicisi olarak bulundu (OR 1.003, p = 0.012); PIV ve SIRI ise düzeltme sonrası anlamlılığını korumadı.
Sonuç: SII şiddetli hastalık ile en güçlü ilişkiyi gösterirken, PIV de evreler boyunca belirgin bir artış sergileyerek yüksek özgüllük sağlamıştır. Genel olarak bu indeksler klinik değerlendirmeyi tamamlayıcı niteliktedir. Hastalık izlemi ve tedavi yanıtındaki yerlerini belirlemek için daha geniş kapsamlı prospektif çalışmalara ihtiyaç vardır.

Keywords

hidradenitis suppurativa , pan-immün-inflamasyon değeri , sistemik inflamasyon yanıt indeksi , sistemik immün inflamasyon indeksi , hastalık şiddeti

References

• McCarthy S. Hidradenitis suppurativa. Annu Rev Med. 2025;76(1):69-80. doi:10.1146/annurev-med-051223-031234
• Holm Nielsen S, Groen SS, Yao Y, et al. Biomarkers of tissue turnover and systemic inflammation are associated with disease severity and activity in patients with hidradenitis suppurativa. J Invest Dermatol. 2023;143(2):328-331.e3. doi:10.1016/j.jid.2022.08.049
• Miller A, Shahzeidi P, Bernhardt M. An update on current clinical management and emerging treatments in hidradenitis suppurativa. Skin Therapy Lett. 2024;29(2):1-6.
• Szepietowski JC, Matusiak Ł. Hidradenitis suppurativa: the disease which stimulates researchers and clinicians. Dermatology. 2020;236(1):5-7. doi: 10.1159/000505542
• Der Sarkissian S, Hessam S, Kirby JS, et al. Identification of biomarkers and critical evaluation of biomarker validation in hidradenitis suppurativa:a systematic review. JAMA Dermatol. 2022;158(3):300-313. doi:10.1001/jamadermatol.2021.4926
• Jiménez-Gallo D, de la Varga-Martínez R, Ossorio-García L, Albarrán-Planelles C, Rodríguez C, Linares-Barrios M. The clinical significance of increased serum proinflammatory cytokines, C-reactive protein, and erythrocyte sedimentation rate in patients with hidradenitis suppurativa. Mediators Inflamm. 2017;2017:2450401. doi:10.1155/2017/2450401
• Gibson RS, Porter ML, Kimball AB. Erythrocyte sedimentation rate, rather than C-reactive protein, may be the preferred biomarker for hidradenitis suppurativa. JAAD Int. 2022;8:47-48. doi:10.1016/j.jdin.2022.04.005
• Li YH, Chuang SH, Yang HJ. Systematic review and meta-analysis of peripheral blood inflammatory markers in hidradenitis Suppurativa. J Dermatol. 2025;52(4):583-592. doi:10.1111/1346-8138.17661
• Basar Kilic S, Erdal H. Pan-immune inflammation value and systemic inflammatory index as a measure of systemic inflammation in patients with psoriasis: a retrospective study. Medicine (Baltimore). 2025;104(10): e41715. doi:10.1097/MD.0000000000041715
• Solak B, Kara RÖ. Systemic inflammation and its relationship with pruritus in early-stage mycosis fungoides. J Cell Mol Med. 2024;28: e18125. doi:10.1111/jcmm.18125
• Susok L, Said S, Reinert D, et al. The pan-immune-inflammation value and systemic immune-inflammation index in advanced melanoma patients under immunotherapy. J Cancer Res Clin Oncol. 2022;148(11): 3103-3108. doi:10.1007/s00432-021-03878-y
• Gambichler T, Stang A, Mansour R, et al. Prognostic potential of the baseline pan-immune-inflammation value and neutrophil/lymphocyte ratio in stage I to III melanoma patients. Cancers (Basel). 2022;14:4410. doi:10.3390/cancers14184410
• Öksüm Solak E, Baran Ketencioglu B, Cinar SL, Kartal D, Borlu M. The role of new inflammatory markers in determining disease activation and severity in patients with hidradenitis suppurativa. Int J Dermatol. 2023;62(8):1076-1081. doi:10.1111/ijd.16744.
• Ozkur E, Karadag AS, Ustuner P, et al. Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity. Clin Exp Dermatol. 2021;46:532-540. doi:10.1111/ced.14478
• Lee JH, Kwon HS, Jung HM, Kim GM, Bae JM. Prevalence and comorbidities associated with hidradenitis suppurativa in Korea: a nationwide population-based study. J Eur Acad Dermatol Venereol. 2018;32:1784-1790. doi:10.1111/jdv.15071
• Omine T, Miyagi T, Hayashi K, Yamaguchi S, Takahashi K. Clinical characteristics of hidradenitis suppurativa patients in Okinawa, Japan: differences between East Asia and Western countries. J Dermatol. 2020; 47:855-862. doi:10.1111/1346-8138.15411
• Yang JH, Moon J, Kye YC, et al. Demographic and clinical features of hidradenitis suppurativa in Korea. J Dermatol. 2018;45:1389-1395. doi: 10.1111/1346-8138.14656
• Gambichler T, Hessam S, Cramer P, Abu Rached N, Bechara FG. Complete blood collection-based systemic inflammation biomarkers for patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2022;36:1593-1596. doi:10.1111/jdv.18175
• Çetinarslan T, Türel Ermertcan A, Özyurt B, Gündüz K. Evaluation of the laboratory parameters in hidradenitis suppurativa: can we use new inflammatory biomarkers? Dermatol Ther. 2021;34(2):e14835. doi:10. 1111/dth.14835
• Hessam S, Sand M, Gambichler T, Bechara FG. Correlation of inflammatory serum markers with disease severity in patients with hidradenitis suppurativa (HS). J Am Acad Dermatol. 2015;73(6):998-1005. doi:10.1016/j.jaad.2015.08.052
• Rotsiamis N, Rompoti N, Liakou A, et al. Systemic inflammation correlates with depression and lower quality of life in patients with hidradenitis suppurativa independent of disease severity. Arch Dermatol Res. 2025;317(1):649. doi:10.1007/s00403-025-04143-9.
• Nielsen VW, Holm JG, Jørgensen AR, Yao Y, Ring HC, Thomsen SF. Liver enzyme levels are associated with markers of systemic inflammation, disease severity, and metabolic syndrome in patients with hidradenitis suppurativa. Health Sci Rep. 2021;4(3):e360. doi:10.1002/hsr2.360
• Holgersen N, Nielsen VW, Rosenø NAL, et al. Biomarkers of systemic inflammation are associated with disease severity and metabolic syndrome in patients with hidradenitis suppurativa. JAAD Int. 2024;15: 170-178. doi:10.1016/j.jdin.2024.03.002