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

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.