Comparative evaluation of the diagnostic value of HALP Score and systemic inflammatory immune index biomarkers in childhood appendicitis

Objective: Abdominal pain is a frequent cause of pediatric emergency admissions. While appendicitis is the most common surgical cause, many non-surgical conditions also exist. Delays in diagnosis increase the risk of perforation. Biomarkers like the Systemic Immune Index (SII) and HALP Score have recently been used to predict prognosis in various conditions, especially cancer. This study aimed to evaluate the diagnostic value of SII and HALP scores in pediatric appendicitis, comparing them with each other and with other commonly used or proposed biomarkers. Methodology: Patients under the age of 18 who were hospitalized in the Pediatric Surgery Clinic of Süleyman Demirel University Faculty of Medicine Hospital with suspicion of appendicitis between 2011 and 2023 were included in this study. Demographic data, lab values, surgical notes and pathology results were reviewed. Patients were grouped as nonspecific abdominal pain (NAP), acute appendicitis (AA) and complicated appendicitis (CA). Results: Among 719 patients, 212 had NAP, 403 had AA and 104 had CA. SII was significantly higher in AA compared to NAP and rose with disease severity (p<0.001). HALP scores differed significantly among all groups (p<0.001). SII better distinguished AA from NAP, while HALP was more effective in identifying CA from AA. Increased SII and decreased HALP were linked to higher risk of AA and CA. Conclusions: No single marker reliably differentiates NAP, AA and CA. This study suggests that SII is useful in identifying AA, while HALP better detects CA, indicating both markers may aid in the diagnostic process of pediatric abdominal pain.