Can the PAN-Immune Inflammation Value Be Used as a Biomarker for Differentiating Epididymo-orchitis and Testicular Torsion in Children?

Öz

Aim: No study in the literature has investigated the role of the pan-immune inflammation value (PIV) in the differential diagnosis of epididymo-orchitis (EO) and testicular torsion (TT) in children. This study aims to evaluate the utility of PIV and other inflammatory indices in the differential diagnosis of EO and TT in children. Material and Method: A retrospective analysis was conducted on 258 children who presented with scrotal pain between January 2019 and December 2023. Patients were divided into EO (n=187) and TT (n=71) groups, with the TT group further classified into orchiectomy (n=24) and detorsion (n=47) subgroups. The diagnostic power of hematological parameters, including derived indices such as PIV, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), in distinguishing TT from EO was investigated. Diagnostic performance was assessed using ROC analysis, and logistic regression models evaluated the predictive value of significant variables. Results: TT patients exhibited significantly higher levels of white blood cells (WBC), neutrophil count, NLR, SIRI, and PIV compared to the EO group. PIV values were found to be significantly higher in the testicular detorsion group compared to the orchiectomy group. ROC analysis demonstrated weak diagnostic performance for NLR (AUC=0.580), SII (AUC=0.568), SIRI (AUC=0.599), and PIV (AUC=0.585), while WBC (AUC=0.673) and neutrophil count (AUC=0.634) showed poor performance. Multivariate logistic regression identified WBC (OR=2.52) and NLR (OR=2.6) as significant predictors of TT, with NLR values >3.39 associated with a 2.6-fold increased likelihood of TT. Conclusion: Our study demonstrates that NLR and WBC, with high specificity, can predict TT, while SIRI and SII have limited diagnostic performance. Although PIV shows potential as a biomarker with varying sensitivity and specificity across different thresholds, its contribution in multivariate models appears less significant. However, it may be effective in predicting testicular viability in TT. Larger sample sizes and multicenter studies are required to further validate the clinical utility of these biomarkers.

Anahtar Kelimeler

• PAN-immune inflammation value
• PIV
• epididymo-orchitis
• testicular torsion
• diagnosis

Kaynakça

1. Chanchlani R, Acharya H. Acute scrotum in children: a retrospective study of cases with review of literature. Cureus. 2023;15:e36259.
2. Diaz EC, Kimball D, Gong EM. Acute scrotal pain in pediatric emergency medicine: evaluation, diagnosis, management, and treatment. Clin Pediatr Emergency Med. 2014;15:248-60.
3. Zadig AM, Ásbjörnsson G, Salö M. Acute scrotum in children. Lakartidningen. 2024;121:23186.
4. Yucel C, Ozlem Ilbey Y. Predictive value of hematological parameters in testicular torsion: retrospective investigation of data from a high-volume tertiary care center. J Int Med. Res. 2019;47:730-7.
5. Baker LA, Sigman D, Mathews RI, et al. An analysis of clinical outcomes using color doppler testicular ultrasound for testicular torsion. Pediatrics. 2000;105:604-7.
6. McBride CA, Patel B. Acutely painful scrotum: tips, traps, tricks and truths. J Paediatr Child Health. 2017;53:1054-9.
7. Kalfa N, Veyrac C, Baud C, et al. Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol. 2004;172:1692-5.
8. Laimer G, Müller R, Radmayr C, et al. Multiparametric ultrasound in torsion of the testicular appendages: a reliable diagnostic tool?. Med Ultrason. 2022;24:33-7.

9. Radmayr C, Bogaert G, Bujons A, et al. EAU Guidelines on Pediatric Urology. 1nd edition. European Association of Urology Guidelines Office, Arnhem, The Netherlands, 2024;26-9.
10. Güven DC, Şahin TK, Erul E, et al. The association between the pan-immune-inflammation value and cancer prognosis: a systematic review and meta-analysis. Cancers. 2022;14:2675.
11. Fucà G, Guarini V, Antoniotti C, et al. The pan-immune-inflammation value is a new prognostic biomarker in metastatic colorectal cancer: results from a pooled-analysis of the Valentino and TRIBE first-line trials. Br J Cancer. 2020;123:403-9.
12. Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Physician. 2013;88:835-40.
13. Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 2018;48:735-44.
14. Yan Y, Chen S, Chen Z, et al. The applied value of medical history, physical examination, colour-Doppler ultrasonography and testis scintigraphy in the differential diagnosis of acute scrotum. Andrologia. Feb 20. 2018. doi: 10.1111/and.12973. [Epub ahead of print].
15. Deng QF, Yang C, Mao C, Chu H. Clinical and hematological analysis of testicular torsion in children. Front Pediatr. 2024;12:1399349.
16. Osumah TS, Jimbo M, Granberg CF, Gargollo PC. Frontiers in pediatric testicular torsion: an integrated review of prevailing trends and management outcomes. J Pediatr Urol. 2018;14:394-401.
17. Radmayr C, Bogaert G, Burgu B, et al. EAU Guidelines on Pediatric Urology. 1nd edition. European Association of Urology Guidelines Office, Arnhem, The Netherlands, 2023;25-7.
18. Canbaz FA, Gerçel G, Sag S. The management of testicular torsion: a survey of Turkish pediatric surgeons and pediatric urologists. Ulus Travma Acil Cerrahi Derg. 2024;30:685-93.
19. Bitkin A, Aydın M, Özgür BC, et al. Can haematologic parameters be used for differential diagnosis of testicular torsion and epididymitis?. Andrologia. 2018;50:1-6.
20. Güneş M, Umul M, Altok M, et al. Predictive role of hematologic parameters in testicular torsion. Korean J Urol. 2015;56:324-9.
21. Peretti M, Zampieri N, Bertozzi M, et al. Mean platelet volume and testicular torsion: new findings. Urol J. 2019;16:83-5.
22. Yilmaz M, Sahin Y, Hacibey I, et al. Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies?. Andrologia. 2022;54:e14374.
23. Yığman M, Ekenci BY, Durak HM, Sancı A. Predictive value of hematologic parameters in the differential diagnosis of testicular torsion and epididymo-orchitis. Androl Bul. 2024;26:167-72.
24. Zhu J, Song Y, Chen G, et al. Predictive value of haematologic parameters in diagnosis of testicular torsion: Evidence from a systematic review and meta-analysis. Andrologia. 2020;52:e13490.
25. Cigsar Kuzu EB, Tiryaki S, Guney N, et al. Low-grade injury following testicular torsion: a multicenter study confirming a disturbing possibility. Urol Int. 2023;107:971-6.