Diagnostic utility of pan-immune inflammation value in drug-naïve first-episode psychosis

OBJECTIVE: To evaluate whether the pan-immune-inflammation value (PIV), derived from blood parameters, can distinguish first-episode psychosis (FEP) from healthy controls (HCs) and to compare its performance with other indices. METHODS: In this retrospective study, 68 drug-naïve patients with FEP and 83 healthy controls were included. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), C-reactive protein-to-albumin ratio (CAR), and PIV were calculated from complete blood count and biochemistry. Receiver operating characteristic (ROC) analysis identified the optimal PIV cut-off, and its diagnostic value was tested using univariate and multivariate logistic regression. RESULTS: Mean PIV values were 378.10 in the FEP group and 170.07 in HCs, with significantly higher levels in patients (p < 0.001). PIV showed the highest discriminative ability (The area under the ROC curve (AUC) = 0.755 (95% CI: 0.674-0.837)). A cut-off of 170.7 yielded 75.0% sensitivity and 72.3% specificity. Individuals with PIV ≥ 170.7 had increased odds of FEP (univariate OR = 7.83; multivariate OR = 9.31 after adjustment for age and sex; p < 0.001). Other indices were also significant but showed lower AUCs. CONCLUSION: PIV may outperform traditional inflammation indices in distinguishing drug-naïve FEP patients from HCs and could support risk stratification.