Pan-immune-inflammation Value as a Potential Inflammatory Marker in Autism Spectrum Disorder

Objective: Neuroinflammation and immune dysregulation are implicated in the etiology of autism spectrum disorder (ASD).This study investigated the relationship between inflammatory markers-pan-immune-inflammation value (PIV), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-lymphocyte-platelet ratio (NLPR), and monocyte-to-lymphocyte ratio (MLR)-and ASD.Methods: A total of 161 children aged 2-6 years were included (87 ASD, 74 controls).Assessments comprised the Childhood Autism Rating Scale, the Ankara Development Screening Inventory, and complete blood count (CBC).Results: The ASD group showed significantly higher NLR, SII, PIV, NLPR, and MLR than controls.Receiver operating characteristic analyses revealed moderate discriminatory performance, with the highest area under the curve for MLR (0.799), followed by PIV (0.775).In age-and sex-adjusted logistic regression, PIV was the strongest independent marker of ASD, followed by NLPR, both with adequate model fit.MLR showed a significant but borderline calibration, whereas NLR and SII demonstrated inadequate goodness-of-fit and should be interpreted with caution.PIV, NLR, SII, and MLR were also associated with autism severity, independent of age, sex, special education attendance, and developmental delay; NLPR was not.Conclusion: To our knowledge, this is the first study to investigate PIV and NLPR in ASD.CBC-derived inflammatory indices, particularly PIV, may have potential as adjunctive markers of case-control differences and clinical severity in early childhood ASD.However, given the moderate performance and single-center retrospective design, these markers should be regarded as candidate adjunctive indicators of immune dysregulation rather than standalone diagnostic tools, requiring prospective validation in independent cohorts before clinical translation.