A recent study published in Indian Journal of Pediatrics found that a biomarker-based composite systemic inflammation score (CSIS), developed using eight routinely available parameters, could help assess inflammation severity in paediatric rheumatic diseases. Changes in the score over time could also reflect disease progression or remission.
The prospective observational study enrolled 117 children with rheumatic diseases, including systemic-onset juvenile idiopathic arthritis (SOJIA), systemic lupus erythematosus (SLE), IgA vasculitis (IgAV) and Kawasaki disease (KD), alongside 50 age-, gender- and temporally matched healthy controls. Associations between disease groups and inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, procalcitonin, ferritin, fibrinogen and albumin, were evaluated. Prediction accuracy was assessed using the area under the receiver operating characteristic curve (AUC).
Comparative analysis showed significantly higher levels of NLR, platelet count, ESR, CRP, D-dimer, ferritin, fibrinogen and albumin in patients than in controls (all p<0.001). These eight significantly associated biomarkers were incorporated into the scoring system, which had a total score ranging from 0 to 16. The CSIS classified inflammatory burden into four categories: no inflammation (0–2), mild inflammation (>2–7), moderate inflammation (>7–10) and severe inflammation (>10). The study concluded that changes in inflammation scores over time can reflect disease progression or remission, allowing for timely interventions and better outcomes.
These findings are consistent with a retrospective study by Nicoară et al. that explored the potential of the systemic immune inflammation index (SII) in reflecting inflammation and disease severity in children with juvenile idiopathic arthritis (JIA), amid growing interest in cellular immune inflammation indices such as NLR and SII as measures of disease severity. The study comprised 74 JIA patients and 50 healthy controls. Median SII values increased with disease severity and correlated strongly with CRP (ρ=0.714), ESR (ρ=0.661), and the JADAS10 score (ρ=0.690). Multiple regression analysis showed SII to be independently associated with JADAS10, and SII accurately distinguished patients with high disease activity from other severity groups (AUC=0.827, sensitivity 81.5%, specificity 66%). These findings suggest that integrating SII as an additional measure holds potential for assessing disease activity in JIA.
References
- Bandhopadhyay D, Bankura B, Hazra A, Sarkar M, Mondal RK. Evaluation of Systemic Inflammation in Pediatric Rheumatic Diseases Using a Composite Systemic Inflammation Score. Indian J Pediatr. 2026 Nov;93(11):1183-1189.
- Nicoară DM, Munteanu AI, Scutca AC, Brad GF, Jugănaru I, Bugi MA, Asproniu R, Mărginean O. Examining the Relationship between Systemic Immune-Inflammation Index and Disease Severity in Juvenile Idiopathic Arthritis. Cells. 2024 Mar 3;13(5):442.