Predictive value of novel inflammatory markers for post-infectious pulmonary embolism in children.
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BACKGROUND: Pulmonary embolism (PE) is an increasingly recognized life-threatening condition in children, characterized by aberrant thrombo-inflammatory responses. New inflammatory markers such as systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio (PLR) are associated with the prediction and prognosis of PE. This study aimed to investigate the expression levels of biological markers such as D-dimer in acute PE of varying severity, and to discuss their correlations, thereby providing a reference for the early clinical identification of children with infection-associated acute PE. METHODS: A retrospective analysis was performed on data from 28 inpatients diagnosed with PE on imaging, including 24 with infection-related PE (post-infectious PE) and 4 with non-infectious PE (all with tumors), and 43 controls without PE on computed tomography pulmonary angiography (CTPA) (control group), all of whom were admitted to the Children's Hospital of Chongqing Medical University from January 2010 to June 2024. The study aimed to compare the levels of novel inflammatory indicators between the groups and to evaluate their predictive value for diagnosing PE. RESULTS: There were 24 cases in the PE group, 9 men and 15 women, with a mean age of 94.42±43.76 months; 43 cases in the control group, 19 men and 24 women, with a mean age of 90.95±44.95 months. The differences in sex composition ratio and age between the two groups were not statistically significant (P>0.05). The values of NLR, MLR, SII, SIRI, and AISI in the PE group were higher than those in the control group (all P<0.05), and multifactorial logistic regression analysis revealed that patients with high levels of NLR, SIRI, and AISI had a higher risk of morbidity. The receiver operating characteristic (ROC) curves showed that the values of NLR [area under the curve (AUC): 0.794; 95% confidence interval (CI): 0.682 to 0.905], SIRI (AUC: 0.861; 95% CI: 0.772 to 0.951) and AISI (AUC: 0.859; 95% CI: 0.766 to 0.953), and AISI had a higher specificity, and the combination of the three had a higher sensitivity. CONCLUSIONS: Elevated NLR, SIRI, and AISI levels were significantly associated with the presence of PE in children with infections, suggesting their utility as adjunctive biomarkers for the early identification of children with PE. NLR emerged as the most robust independent predictor. Given the cross-sectional design and limited sample size, the predictive value for disease severity or prognosis was not evaluated.