Systemic Immune‐Inflammation Index as a Predictor of Ovarian Necrosis in Children With Incarcerated Ovary Hernia: A Single‐Centre Retrospective Study

AIM: Ovarian necrosis is a severe complication of incarcerated ovary hernia in female children, yet reliable preoperative predictors are lacking. We aimed to evaluate the systemic immune-inflammation index (SII) as a predictor of ovarian necrosis and to compare its diagnostic performance with the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP). METHODS: We retrospectively reviewed female children who underwent emergency surgery for incarcerated ovary or fallopian-tube hernia between October 2018 and April 2026. SII was calculated as platelet count × neutrophil count/lymphocyte count and NLR as neutrophil count/lymphocyte count. Univariable Firth-penalised logistic regression and receiver-operating-characteristic (ROC) analyses were performed. AUCs were estimated with DeLong 95% confidence intervals, optimal cut-offs by the Youden index, and AUCs were compared using the DeLong test. RESULTS: Among 45 patients, 10 (22.2%) had intraoperatively confirmed ovarian necrosis. SII and CRP were significantly associated with necrosis in univariable Firth analyses. SII showed an AUC of 0.894 (95% CI 0.790-0.999), sensitivity 90.0%, and specificity 85.7%. NLR showed an AUC of 0.917 (95% CI 0.836-0.998), sensitivity 100.0%, and specificity 80.0%. The AUCs of SII and NLR did not differ significantly (DeLong p = 0.542). CRP had an AUC of 0.867 (95% CI 0.681-1.000), sensitivity 80.0%, and specificity 94.3%. CONCLUSIONS: SII showed good discrimination for ovarian necrosis in paediatric incarcerated ovary hernia, but did not outperform the simpler NLR in this small cohort. Both CBC-derived indices may assist preoperative risk stratification; however, the proposed thresholds are exploratory and require prospective multicentre external validation before clinical implementation.