{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:22:13Z","timestamp":1793215333564,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Myocarditis is a major cause of morbidity and mortality in children and can lead to long-term heart failure, dilated cardiomyopathy, the need for heart transplantation, or death. New systemic inflammatory indices that combine lymphocyte, neutrophil, and platelet counts have been recently used as strong prognostic markers of some inflammatory diseases and adverse outcomes of neoplasms. This study aimed to investigate the use of new systemic indices as early predictive markers for adverse outcomes in patients with pediatric myocarditis. Methods: This study retrospectively examined patients between the ages of &gt;1 month and &lt;18 years who were monitored in our clinic with a diagnosis of myocarditis between 1 January 2022 and 31 December 2024. The cases were divided into two groups: fulminant myocarditis (requiring the use of inotropes or extracorporeal membrane oxygenation due to hemodynamic disturbance) and non-fulminant myocarditis. The systemic inflammatory index values of these groups (calculated in the first 6 h) were compared, and the results were statistically analyzed. Results: The study included 122 pediatric myocarditis cases treated during the study period (80 boys; median age: 11 (IQR: 8\u201314) years). Twenty-six of these patients (21.3%) developed fulminant myocarditis. The median systemic immune-inflammation index (SII) value in the group with fulminant myocarditis was 1300 (IQR: 1000\u20131600), while this value was 500 (IQR: 350\u2013650) for the non-fulminant group (p &lt; 0.05). The median systemic inflammatory response index (SIRI) values were 2.9 (IQR: 2.5\u20133.2) in the fulminant myocarditis group and 1.5 (IQR: 1.2\u20131.8) in the non-fulminant group (p &lt; 0.05). The cut-off values for fulminant myocarditis were found to be 1050 for the SII, with an AUC value of 0.76 (95% confidence interval: 0.80\u20130.96; p &lt; 0.001), and 1.9 for the SIRI, with an AUC value of 0.64. Conclusions: The SII and SIRI may independently predict adverse myocarditis prognoses in children. These new biomarkers are easy to calculate using routine blood parameters.<\/jats:p>","DOI":"10.3390\/diagnostics15080961","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T11:26:41Z","timestamp":1744284401000},"page":"961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["New Systemic Inflammatory Indices as Predictors of Fulminant Myocarditis in Children"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5360-7044","authenticated-orcid":false,"given":"Demet","family":"Kangel","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130sa","family":"Ozy\u0131lmaz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sercin","family":"Ozkok","sequence":"additional","affiliation":[{"name":"Department of Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice Dilek","family":"\u00d6zcano\u011flu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3314-9090","authenticated-orcid":false,"given":"Ali Naz\u0131m","family":"G\u00fczelba\u011f","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcu","family":"\u00c7evlik","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim Cansaran","family":"Tan\u0131d\u0131r","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Can","family":"Hatemi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovascular Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-3269","authenticated-orcid":false,"given":"Erkut","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.4070\/kcj.2020.0108","article-title":"Acute myocarditis in children: A 10-year nationwide study (2007\u20132016) based on the Health Insurance Review and Assessment Service Database in Korea","volume":"50","author":"Kim","year":"2020","journal-title":"Korean Circ. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.amjcard.2021.03.019","article-title":"Trends in acute myocarditis related pediatric hospitalizations in the United States, 2007\u20132016","volume":"149","author":"Vasudeva","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jacc.2024.10.080","article-title":"2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"85","author":"Drazner","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"773","DOI":"10.29271\/jcpsp.2022.06.773","article-title":"Systemic immune inflammation index as a reliable disease activity marker in psoriatic arthritis","volume":"32","author":"Dincer","year":"2022","journal-title":"JCPSP-J. Coll. Physicians Surg. Pak."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.2147\/CIA.S339221","article-title":"The predictive role of systemic inflammation response index (SIRI) in the prognosis of stroke patients","volume":"16","author":"Zhang","year":"2021","journal-title":"Clin. Interv. Aging"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Guven, D.C., Sahin, T.K., Erul, E., Kilickap, S., Gambichler, T., and Aksoy, S. (2022). The association between the pan-immune-inflammation value and cancer prognosis: A systematic review and meta-analysis. Cancers, 14.","DOI":"10.3390\/cancers14112675"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e40904","DOI":"10.1097\/MD.0000000000040904","article-title":"New systemic inflammatory indices as predictors of ascending aortic dilation in children with bicuspid aortic valve: A retrospective cross-sectional study","volume":"103","author":"Arslan","year":"2024","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00246-022-02988-9","article-title":"A novel marker for predicting fulminant myocarditis: Systemic immune\u2013inflammation index","volume":"44","author":"Bodur","year":"2023","journal-title":"Pediatr. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases","volume":"34","author":"Caforio","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6212","DOI":"10.1158\/1078-0432.CCR-14-0442","article-title":"Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma","volume":"20","author":"Hu","year":"2014","journal-title":"Clin. Cancer Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1002\/cncr.30057","article-title":"A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy","volume":"122","author":"Qi","year":"2016","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1038\/s41416-020-0894-7","article-title":"The Pan-Immune-Inflammation Value is a new prognostic biomarker in metastatic colorectal cancer: Results from a pooled-analysis of the Valentino and TRIBE first-line trials","volume":"123","author":"Guarini","year":"2020","journal-title":"Br. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1080\/17520363.2024.2403321","article-title":"Prognostic role of systemic immune-inflammation index versus other cardiac markers in acute myocarditis in young adults","volume":"18","author":"Erbay","year":"2024","journal-title":"Biomark. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tang, Y., Zeng, X., Feng, Y., Chen, Q., Liu, Z., Luo, H., Zha, L., and Yu, Z. (2021). Association of systemic immune-inflammation index with short-term mortality of congestive heart failure: A retrospective cohort study. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.753133"},{"key":"ref_15","first-page":"58","article-title":"Systemic immune-inflammation index predicts mortality in infective endocarditis","volume":"32","author":"Agus","year":"2020","journal-title":"J. Saudi Heart Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wang, X., Ni, Q., Wang, J., Wu, S., Chen, P., and Xing, D. (2022). Systemic inflammation response index is a promising prognostic marker in elderly patients with heart failure: A retrospective cohort study. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.871031"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Xu, T., Song, S., Zhu, K., Yang, Y., Wu, C., Wang, N., and Lu, S. (2025). Systemic inflammatory response index improves prognostic predictive value in intensive care unit patients with sepsis. Sci. Rep., 15.","DOI":"10.1038\/s41598-024-81860-7"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Xia, Y., Xia, C., Wu, L., Li, Z., Li, H., and Zhang, J. (2023). Systemic immune inflammation index (SII), system inflammation response index (SIRI) and risk of all-cause mortality and cardiovascular mortality: A 20-year follow-up cohort study of 42,875 US adults. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031128"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"S\u00f6\u011f\u00fctl\u00fc, Y., and Alta\u015f, U. (2024). Predictive Value of Neutrophil\u2013Lymphocyte Ratio and Other Inflammation Indices in Febrile Seizures in Children. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175330"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Xu, H.-B., Xu, Y.-H., He, Y., Lin, X.-H., Suo, Z., Shu, H., and Zhang, H. (2024). Association between admission pan-immune-inflammation value and short-term mortality in septic patients: A retrospective cohort study. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-66142-6"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00246-004-0677-6","article-title":"Cardiac troponin T: A marker in the diagnosis of acute myocarditis in children","volume":"26","author":"Soongswang","year":"2005","journal-title":"Pediatr. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1007\/s00246-018-1871-2","article-title":"Elevated troponin in the first 72 h of hospitalization for pediatric viral myocarditis is associated with ECMO: An analysis of the PHIS+ database","volume":"39","author":"Butto","year":"2018","journal-title":"Pediatr. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Da, M., Yang, X., Xu, Y., and Qi, J. (2024). A retrospective analysis of clinical characteristics and outcomes of pediatric fulminant myocarditis. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-05022-4"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/joa3.12751","article-title":"Clinical and electrocardiographic characteristics in patients with fulminant myocarditis","volume":"38","author":"Itoh","year":"2022","journal-title":"J. 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