Discriminatory Performance of Systemic Inflammation Response Index in Pediatric Eosinophilic Esophagitis

Objective: This study aimed to evaluate the discriminatory performance of hemogram-derived inflammatory parameters in distinguishing pediatric eosinophilic esophagitis (EoE) from symptomatic controls. To determine their potential value as non-invasive tools for longitudinal monitoring, whether these markers correlate with endoscopic and histologic activity during follow-up was also assessed. Methods: This retrospective, longitudinal study included pediatric patients who underwent upper gastrointestinal endoscopy at a tertiary pediatric gastroenterology center between August 2022 and August 2025. Children presenting with dysphagia, vomiting, or abdominal pain who had esophageal, gastric, and duodenal biopsies were evaluated. Eosinophilic esophagitis was diagnosed based on symptoms and the presence of ≥15 eosinophils per high-power field in esophageal biopsies. Symptomatic children with similar age and sex distribution without esophageal eosinophilia served as controls. Hemogram results obtained within 1 week before each endoscopy were analyzed. Hemogram-derived indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index [SIRI], aggregate index of systemic inflammation, mean platelet volume-to-lymphocyte ratio, mean platelet volume-to-platelet ratio, and red cell distribution width-to-platelet ratio) were calculated. Diagnostic performance was assessed using receiver-operating characteristic analyses, and associations with endoscopic and histologic findings were examined using linear mixed-effects models. Results: Children with EoE showed significantly higher absolute eosinophil counts and markedly elevated SIRI values at diagnosis compared with controls (P < .001). Systemic inflammation response index demonstrated excellent discriminatory performance, whereas most other hemogram-derived indices showed limited accuracy. During follow-up, none of the hemo- gram-derived parameters—including SIRI—correlated with endoscopic or histologic activity. Conclusion: Systemic inflammation response index demonstrated high discriminatory performance in distinguishing pediatric EoE from symptomatic controls, but showed no association with longitudinal disease activity. Endoscopic and histologic assessments remain essential for diagnosis and monitoring.