Predictive role of inflammatory indexes in systemic manifestations of pediatric Behçet’s disease

TL;DR

This study shows that inflammatory blood markers can help identify children with Behçet’s disease who are at risk for serious organ complications.

Contribution

This is the first study to investigate inflammatory indexes in pediatric Behçet’s disease for predicting systemic involvement.

Findings

Inflammatory indices were significantly higher in patients with systemic, neurological, and vascular involvement.

Optimal cut-off values for each index were established to predict systemic involvement.

Routine assessment of these markers could improve early detection and management of complications.

Abstract

Behçet’s disease (BD) is a multisystem autoinflammatory disorder that may present during childhood. Pediatric BD is challenging to diagnose due to heterogeneous clinical manifestations and the lack of standardised pediatric classification criteria. This study aimed to evaluate the association between systemic inflammatory biomarkers—including the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and C-reactive protein (CRP)/albumin ratio—and systemic organ involvement in children with BD. To our knowledge, no prior study has investigated these markers in pediatric BD.

In this retrospective study, 41 pediatric patients diagnosed with BD according to the 2015 PEDBD criteria and followed jointly by dermatology and rheumatology departments were included. Age- and sex-matched healthy controls (n = 41) undergoing elective surgery were also enrolled. Inflammatory indices (NLR, SII, PIV, CRP/albumin) were calculated from pre-treatment blood samples. Cut-off values for systemic involvement were determined via ROC analysis. Statistical analyses included the Kolmogorov-Smirnov test, independent t-test or Wilcoxon test, Chi-square and McNemar tests, correlation analysis, logistic regression, and ROC analysis.

Systemic involvement was observed in 28 (68.3%) patients, including neurological involvement in 4 (9.8%), vascular involvement in 5 (12.2%), and other major organ involvement in 19 (46.3%). Inflammatory indices—PIV, SII, NLR, and CRP/albumin—were significantly higher in patients with systemic, neurological, and vascular involvement (all p < 0.05). Optimal cut-off values for each index were established based on systemic involvement.

Systemic inflammatory biomarkers such as NLR, SII, PIV, and CRP/albumin ratio may serve as useful indicators of systemic organ involvement in pediatric BD. Routine assessment of these markers could facilitate earlier recognition and more targeted management of systemic manifestations in this population.

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