A New Biomarker in the Diagnosis of Pediatric Corrosive Esophagitis: Pan-Immune Inflammatory Score and Systemic Inflammatory Index: Can esophagoscopy be omitted in asymptomatic patients?

A New Biomarker in the Diagnosis of Pediatric Corrosive Esophagitis: Pan-Immune Inflammatory Score and Systemic Inflammatory Index: Can esophagoscopy be omitted in asymptomatic patients? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A New Biomarker in the Diagnosis of Pediatric Corrosive Esophagitis: Pan-Immune Inflammatory Score and Systemic Inflammatory Index: Can esophagoscopy be omitted in asymptomatic patients? Hülya İpek, Gül Doğan, Mehmet Metin, Nurcan Çoşkun, Çağatay Evrim Afşarlar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8087399/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective : In our study, we aimed to investigate the effect on prognosis by evaluating whether there is a relationship between NLR, PLR, SII, SIRI, and PIV levels and symptoms in our patients who ingested corrosive substances. Additionally, we aimed to investigate the feasibility of using biomarkers as an alternative to endoscopy, an invasive procedure, thereby contributing to the development of a rapid and low-cost diagnostic approach in clinical management. Material and Methods: We retrospectively analyzed 213 pediatric cases aged 0-18 years who presented to our hospital with corrosive esophagitis between 2018 and 2023. In the study, demographic data (age and gender) and laboratory parameters were recorded for each patient, and inflammation indices derived from these data, namely SII, SIRI, and PIV indices, were determined. Patients were examined in three groups according to the type of substance they swallowed: detergents, bleach and other corrosive substances, and sink unblockers and limescale removers. Additionally, two subgroups were formed based on the presence of symptoms: symptomatic and asymptomatic. Statistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA, License: Hitit University). Kolmogorov-Smirnov and Shapiro-Wilks tests, histograms, and Q-Q plots were used to assess the normal distribution of numerical data. Variance homogeneity was tested using the Levene test.In our study, neutrophil levels were significantly higher in the symptomatic group (p=0.016), while lymphocyte levels were lower (p=0.007). Consequently, NLR was markedly elevated in the symptomatic group (p=0.002). A sensitivity of 61.1% and a specificity of 90.3% were obtained for NLR. Similarly, PLR (p=0.006), SII (p=0.004), SIRI (p=0.020), and PIV (p=0.019) values were also found to be significantly higher in the symptomatic group. The likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR=6.66; 95% CI: 1.04–42.9; p=0.046). Furthermore, the risk of symptom development in patients with NLR ≥2.15 was significantly higher compared to those with low NLR levels (OR=17.6; 95% CI: 5.6–55.5; p<0.001). Conclusion: Blood parameter values are predicted to be a good indicator of the severity of corrosive esophagitis and may help predict the degree of mortality and morbidity. This prevents unnecessary endoscopies as an invasive method. corrosive esophagitis pan immune inflammation systemic inflammatory index children Figures Figure 1 Introduction Lesions formed in the esophagus as a result of ingesting corrosive substances (acid or alkali) in liquid or solid form are called corrosive esophagitis [1,2]. Such accidents are common in the pediatric age group and constitute a significant health problem in our country. Corrosive substances are divided into two main groups according to their chemical content: basic and acidic. Acidic substances cause coagulation necrosis in the affected tissue, resulting in more superficial damage. Basic substances, on the other hand, cause liquefactive necrosis in the tissue, leading to deeper and more extensive damage [3,4]. Full-thickness burns, perforation, and stricture development, especially in the thoracic esophagus, cause significant morbidity and mortality. Long-term complications include esophageal stricture development and gastrointestinal morbidity risk, which varies between 7–25% [5,6]. The unresolved debate surrounding the management of corrosive substance ingestion poses a significant problem for both patients and healthcare systems. The clinical management of corrosive substance ingestion is directly related to the extent of damage caused and the development of strictures. Current guidelines recommend endoscopic evaluation within 24–48 hours after corrosive substance exposure [7,8]. However, some researchers argue that endoscopy may yield a high rate of false-negative results and should only be performed according to specific criteria [9,10,11]. The current literature highlights the mismatch between symptom severity and the severity of esophageal injury as a significant clinical challenge. Determining the patient's prognosis based on the chemical properties of the ingested corrosive substance is often difficult [12]. Therefore, it is challenging for clinicians to quickly assess the patient's current condition based on the various characteristics of the ingested product. This situation requires a reliable, easy, rapid, and reproducible biomarker to diagnose the presence and severity of burns after suspected caustic ingestion, as there is no consensus on patient management. Recently, parameters obtained from complete blood counts (CBC) have attracted attention as cost-effective and accessible biomarkers for assessing systemic inflammation in various diseases. A complete blood count is easy to perform, inexpensive, and provides information about morphological parameters (white blood cell count, lymphocyte count, neutrophil count, monocyte count, platelet count, and mean platelet volume). The combined ratios of these parameters are used as inflammation indices and assist in the diagnosis, progression, and risk assessment of many diseases. The systemic immune-inflammation (SII) index (calculated as platelet count × NLR) is increasingly used to evaluate the immune response, along with NLR and PLR. A review of the literature revealed no studies evaluating NLR, PLR, SII, and SIRI together with PIV in pediatric patients who ingested corrosive substances. In our study, we aimed to evaluate the relationship between NLR, PLR, SII levels and symptoms in patients who ingested corrosive substances, to assess their effect on prognosis and to evaluate the potential of predicting the severity of esophageal burns using complete blood count parameters. Specifically, by analyzing the prognostic values of markers such as the Systemic Immune-Inflammation Index (SII), SIRI, and PIV score, we aimed to identify alternative diagnostic approaches that could reduce the necessity for endoscopy, an invasive procedure for pediatric patients. The limitations of our study are that it is retrospective and single-center. Material and Methods After obtaining informed consent from all legal guardians and/or children and approval from Institutional Ethics Committee of Hitit University Faculty of Medicine (date: 03.01.2024, decision number: 2023-22), between December 2018–2023, 213 pediatric cases (under 18 years of age) treated at our hospital as outpatients or inpatients for corrosive esophagitis were retrospectively analyzed for correlations between gender, age, types of corrosive substances, symptoms, physical examination findings, and patients' blood values. The study recorded demographic data (age and gender) and laboratory parameters (hemoglobin, WBC, monocytes, neutrophils, lymphocytes, platelets, and albumin) for each patient and calculated the following inflammation indices derived from these data: NLR = Neutrophil/Lymphocyte, PLR = Platelet/Lymphocyte, SII = (Platelet × Neutrophil)/Lymphocyte, SIRI = (Neutrophil × Monocyte)/Lymphocyte, PIV = (Neutrophil × Monocyte × Platelet)/Lymphocyte. Patients were classified in three groups according to the type of substance they ingested: detergents, bleach and other corrosive substances, and drain cleaners and limescale removers. In addition, two subgroups were formed according to the presence of symptoms: symptomatic and asymptomatic. Statistical Analysis Statistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA, License: Hitit University). Graphs were produced using the ggplot2 library in R Studio version 2023.06.2 (R Foundation for Statistical Computing, Vienna, Austria; https://www.r-project.org ). Descriptive statistics for categorical variables were presented as frequency (n) and percentage (%). Differences in proportions between groups were assessed using the chi-square test. Continuous variables were reported as mean ± standard deviation (SD) when they met the assumption of normal distribution, and as median (Q1–Q3) when they did not. Kolmogorov-Smirnov and Shapiro-Wilks tests, histograms, and Q-Q plots were used to assess the normal distribution of numerical data. Variance homogeneity was tested using the Levene test. For comparisons between two independent groups, Student's t-test was used when parametric assumptions were met, and the Mann-Whitney U test was used when they were not met. When parametric assumptions were met in the comparison of three or more independent groups, one-way ANOVA was applied; when they were not met, the Kruskal-Wallis test was applied. Dunn-Bonferroni post hoc pairwise comparisons were performed in cases where significant differences were detected with the Kruskal-Wallis test. ROC analysis was performed to evaluate the performance of inflammation indices in predicting symptom presence. ROC curves, AUC values, and 95% confidence intervals were calculated. AUC values were interpreted as excellent (0.9–1), good (0.8–0.9), moderate (0.7–0.8), poor (0.6–0.7), and very poor (0.5–0.6). The optimal cut-off points in the ROC analysis were determined using the Youden index; sensitivity and specificity rates were calculated for these values. In addition, univariate and multivariate binary logistic regression analyses were performed to evaluate the effect of the new categorical variables created according to the determined optimal cut-off values on symptom prediction. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each statistically significant parameter. A p-value < 0.05 was considered statistically significant in all tests. Results A total of 213 patient records were analyzed in the study. Of the patients, 106 (49.8%) were female and 107 (50.2%) were male. When the distribution was investigated according to the groups of ingested substances, 68 patients (31.9%) ingested detergent, 98 patients (46%) ingested bleach and corrosive substances, and 47 patients (22.1%) ingested drain cleaner and limescale remover. The rate of patients without symptoms was 91.5% (n = 195), while the rate of patients who developed symptoms was 8.5% (n = 18). The mean age in the entire sample was 5.35 ± 5.98 years (min–max: 0–18). The average length of stay was 0.51 ± 2.67 days, and the longest length of stay was determined to be 35 days. Comparative findings of demographic characteristics, laboratory parameters, and inflammation indices between the study groups are presented in Table 1 . No significant differences were found between the ingested substance groups in terms of gender distribution, age, length of stay, monocytes, neutrophils, lymphocytes, platelets, albumin, WBC, NLR, PLR, SII, SIRI, and PIV (all p > 0.05, Table 1 ). However, a significant difference was found between the groups in terms of hemoglobin levels (p = 0.014). Post-hoc analyses showed that hemoglobin values were significantly higher in the detergents group (p = 0.037) and the bleach and other corrosive substances group (p = 0.017) as compared to the drain openers and lime removers groups. The findings obtained from comparisons based on symptom presence are presented in Table 2 . While neutrophil levels were significantly higher (p = 0.016), lymphocyte levels were lower (p = 0.007) in the symptomatic group. Consequently, NLR was markedly elevated in the symptomatic group (p = 0.002). Similarly, PLR (p = 0.006), SII (p = 0.004), SIRI (p = 0.020), and PIV (p = 0.019) values were also significantly higher in the symptomatic group. No significant differences were observed between the groups in terms of gender, age, length of stay, monocytes, hemoglobin, platelets, albumin, and WBC (all p > 0.05, Table 2 ). The performance of inflammation indices in predicting symptom development was evaluated by ROC analysis (Table 3 ). According to the ROC results, the highest AUC value for distinguishing symptom presence was calculated for NLR (AUC = 0.723; 95% CI: 0.557–0.888). Considering the optimal cutoff point of 2.15 determined by the Youden index for NLR, 61.1% sensitivity and 90.3% specificity were obtained. The PLR (AUC = 0.695), SII (AUC = 0.705), SIRI (AUC = 0.666), and PIV (AUC = 0.667) indices also showed meaningful performance in symptom differential diagnosis. While specificity values ranged from 88% to 95% for these parameters, sensitivity values ranged from 55% to 78%. The distributions of NLR and SII, which had AUC values greater than 0.700 in the symptom groups, are shown in Fig. 1 along with the optimal cut-off points. The findings of the logistic regression analysis are presented in Table 4 . In univariate analyses, gender and age had no significant effect on symptoms (p = 0.638 and p = 0.612, respectively). Compared to the detergent group, the risk of symptom development was significant at the p = 0.10 level in the bleach and corrosive substance group (p = 0.069). However, the likelihood of symptom development in the drain openers and descalers group was not significantly different from that in the detergent group (p = 0.111). The risk of symptom development in patients with NLR ≥ 2.15 was significantly higher compared to those with low NLR levels (OR = 14.6; 95% CI: 5.05–41.9; p < 0.001). Although gender and age were not statistically significant in the univariate model, they were included in the multivariate model to refine the effect. According to the multivariate model findings, the likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR = 6.66; 95% CI: 1.04–42.9; p = 0.046). Furthermore, the risk of symptom development in patients with NLR ≥ 2.15 was significantly higher compared to those with low NLR levels (OR = 17.6; 95% CI: 5.6–55.5; p < 0.001). The explanatory power of the multiple logistic regression model was Nagelkerke R²=0.305, and the classification accuracy was calculated as 92.5%. Table 1 Comparison of demographic, laboratory parameters, and inflammation indices between the research groups Variable Detergents (n = 68) (1) Bleach and Other Corrosive Substances (n = 98) (2) Drain Openers and Lime Removers (n = 47) (3) P Post-hoc P Gender F 35 (51.5%) 46 (46.9%) 25 (53.2%) 0.736 a - M 33 (48.5%) 52 (53.1%) 22 (46.8%) Age 2 (1–12.5) 2 (1–9) 2 (1–5) 0.928 c - Length of Hospital Stay (day) 0 (0–0) 0 (0–0) 0 (0–0) 0.187 c - Monocyte 1.77 ± 0.81 1.76 ± 0.74 1.84 ± 0.8 0.813 b - Hb 12.8 (12.5–13.2) 12.7 (12.5–13.4) 12.5 (12.3–12.7) 0.014 c 1–2: 1.000 1–3: 0.037 2–3: 0.017 Neutrophil 6.41 ± 2.78 6.25 ± 2.8 5.66 ± 2.49 0.331 b - Lymphocyte 5.81 ± 2.49 5.81 ± 2.67 5.95 ± 2.26 0.944 b - PLT 307.8 ± 66.17 309.6 ± 59.77 305 ± 71.58 0.922 b - Albumin 42 (41–45) 43 (41-45.25) 43 (41–45) 0.831 c - WBC 10.6 ± 2.6 10.35 ± 2.34 10.89 ± 2.31 0.444 b - NLR 1.05 (0.73–1.67) 1.02 (0.68–1.68) 0.94 (0.68–1.37) 0.367 c PLR 59.02 (43.22–76.81) 59.21 (38.05–84.67) 53.17 (39.25–71.35) 0.668 c SII 304.1 (210.9-497.1) 321 (190.7-483.5) 296.4 (186.8 -400.8) 0.371 c SIRI 1.92 (1.08–3.22) 1.77 (0.95–3.12) 1.49 (0.97–2.74) 0.571 c PIV 568.8 (343.1–1007) 502.9 (260.9–963.5) 454 (262.2–773) 0.534 c a Chi-Square with n (%) b One-way ANOVA with mean ± standard deviation (SD) c Kruskal wallis test followed Dunn-Bonferroni post-hoc tests with median (Q1-Q3) F: Female, M: Male, Hb: Hemoglobin, PLT: platelets, WBC: White Blood Cell, NLR: Neutrophil-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammatory Response Index, PIV: Pan-Immune-Inflammation Value Table 2 Statistical comparison of demographic characteristics, laboratory parameters, and inflammation indices among symptom groups Groups P values Asymptomatic (n = 195) Symptomatic (n = 18) Gender F 98 (50.3%) 8 (44.4%) 0.637 a M 97 (49.7%) 10 (55.6%) Age 2 (1–9) 2 (1–6) 0.909 e Length of Hospital Stay (day) 0 (0.53 ± 2.79) 0 (0 .28 ± 0.46) 0.267 e Monocyte 1.77 ± 0.76 1.85 ± 0.91 0.710 d Hb 12.7 (12.4–13.2) 12.65 (12.5–13.25) 0.992 e Neutrophil 6.03 ± 2.64 7.64 ± 3.27 0.016 d Lymphocyte 5.98 ± 2.48 4.31 ± 2.46 0.007 d PLT 307 ± 63.1 318.7 ± 77.4 0.462 d Albumin 43 (41–45) 43.5 (41–46.25) 0.741 e WBC 10.5 ± 2.44 10.8 ± 2.18 0.605 d NLR 1 (0.68–1.57) 2.84 (0.83–3.74) 0.002 e PLR 54.3 (39.6–77.1) 77.5 (60.8–146.7) 0.006 e SII 300.3 (199–453.8) 785.8 (214.1–1282) 0.004 e SIRI 1.72 (0.97–2.85) 5.04 (0.99–8.23) 0.020 e PIV 498.1 (273–839.7) 1469.4 (202.9–2632) 0.019 e a Chi-square test d Student’s t test e Mann-Whitney U test F: Female, M: Male, Hb: Hemoglobin, PLT: platelets, WBC: White Blood Cell, NLR: Neutrophil-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammatory Response Index, PIV: Pan-Immune-Inflammation Value Table 3 Results of ROC analysis for inflammation indices in predicting symptoms, with cut-off values and corresponding sensitivity and specificity Variables AUC 95% CI Cut-off Sensitivity Specificity Lower Bound Upper Bound NLR 0.723 0.557 0.888 2.15 %61.1 %90.3 PLR 0.695 0.545 0.845 65.87 %77.8 %63.1 SII 0.705 0.534 0.876 738.5 %61.1 %92.3 SIRI 0.666 0.486 0.845 5.01 %55.6 %94.9 PIV 0.667 0.483 0.851 1186 %61.1 %88.2 NLR: Neutrophil-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammatory Response Index, PIV: Pan-Immune-Inflammation Value, AUC: Area Under Curve, CI: Confidence Interval Table 4 Results of univariate and multivariate binary logistic regression analyses to determine the effect of risk factors on predicting symptoms Univariate Multivariate P values OR (CI 95%) P values OR (CI 95%) Gender (Male vs. female) 0.638 - 0.543 - Age 0.612 - 0.619 - Substance Type Bleach and other corrosive substances vs. detergents 0.069 4.17 (0.89–19.47) 0.083 4.27 (0.83–22.1) Drain openers and lime removers vs. detergents 0.111 3.93 (0.73–21.18) 0.046 6.66 (1.04–42.9) NLR (≥ 2.15 vs < 2.15) < 0.001 14.6 (5.05–41.9) < 0.001 17.6 (5.6–55.5) Multivariate model: Nagelkerke R Square = 0.305, Classification accuracy: 92.5% Values below P < 0.05 were shown bold OR: Odds ratio, CI: Confidence interval, NLR: Neutrophil-to-Lymphocyte Ratio Discussion Although corrosive substance ingestion is a rare health problem in developed countries due to the safety measures taken, it remains a significant cause of morbidity and mortality in developing countries [13]. Injuries related to corrosive substance ingestion are particularly common in the childhood age group. Although there has been a marked decrease in incidence in the United States (US) since the 1960s due to legal regulations on hazardous household chemicals, it is reported that there are between 5,000 and 15,000 cases of corrosive substance ingestion annually [14,15]. Although there are no definitive recorded data for Turkey, the annual number of cases is estimated to be between 3,000 and 5,000 [16]. The accidental ingestion of products with high chemical content, such as household cleaners, bleach, limescale removers, and grease removers, by children due to carelessness or inadequate safety measures is considered a common and preventable health problem in pediatric surgery clinics. Leaving such products exposed during cleaning further increases the likelihood of ingestion [17]. When the ingsted substances are overviewed, it is obvious that most of these substances are poured into cups by parents during cleaning and forgotten in an easily accessible place. In addition, open types that are filled into different bottles instead of factory-sealed boxes are more frequently preferred and perceived by children as drinkable. Although there are series in the literature showing that symptoms are not effective in determining esophageal damage, there are also series showing that the degree of damage and future strictures are always related to symptoms and signs. The current literature indicates that the mismatch between the severity of symptoms and the severity of esophageal damage is a significant clinical challenge [18]. Furthermore, determining the patient's prognosis based on the chemical properties of the corrosive substance is often difficult. The clinical management of corrosive substance ingestion is directly related to the degree of damage and the development of strictures. Current guidelines recommend endoscopic evaluation within 24–48 hours after exposure [19,20]. However, some researchers argue that endoscopy may yield a high rate of false-negative results and should only be performed according to specific criteria [21,22]. In one study, 968 pediatric patients were evaluated over a 22-year period at a center where endoscopy was not routinely performed, and it was found that only 13.5% of all patients developed long-term esophageal stricture. One disadvantage of endoscopy is that it cannot detect transmural or submucosal tissue damage. For example, a study in which physicians at a tertiary center performed endoscopy to evaluate the esophagus after corrosive substance ingestion showed that 56.9% of endoscopies were normal [23]. Consequently, many studies in the literature report unnecessary endoscopy rates between 60% and 80% [24]. On the other hand, there is no reliable predictor to determine the presence and severity of corrosive esophagitis prior to endoscopic evaluation, including the presence of oropharyngeal injuries [25, 26]. Therefore, since symptoms and physical examination cannot be relied upon to confirm esophageal burns after caustic substance ingestion, most patients are either missed or subjected to unnecessary endoscopies that should not be performed. Consequently, there is a growing need for a reliable, easy, rapid, and reproducible biomarker that can predict the presence and severity of esophageal damage after exposure to corrosive substances. A review of the literature reveals no studies evaluating NLR, PLR, SII, SIRI, and PIV scores together in pediatric patients who have ingested corrosive substances. In our study, we aimed to investigate the effect on prognosis by evaluating whether there is a relationship between NLR, PLR, SII, SIRI, and PIV levels and symptoms in our patients who ingested corrosive substances. We also aimed to contribute to the development of a rapid and low-cost diagnostic approach in clinical management by investigating the usability of biomarkers as an alternative to endoscopy, which is an invasive procedure. When children admitted to the hospital due to corrosive substance ingestion were evaluated by age group, the mean age in our study was found to be 5.35, similar to the literature. It was observed that the ingested substances were mostly cleaning agents sold openly [27]. The most common complaints among patients presenting to the hospital were vomiting and hypersalivation. Physical examination findings revealed redness inside and around the mouth. Akbay and Öner et al., as well as Biçer and colleagues [28], reported that hyperemia and edema of the oral mucosa were the most common physical findings in children. Our results are similar to those reported in the aforementioned studies. Gupta et al. also reported that endoscopic examination of asymptomatic patients revealed no pathological findings and that advanced injuries were only detected in patients with severe symptoms [29]. In light of the findings obtained in the multicenter study conducted by Di Nardo et al., they recommended that only symptomatic patients undergo endoscopy [30]. Similarly, a multicenter study conducted in the United States on 285 children concluded that the incidence of significant injuries without any signs or symptoms was very low and that endoscopy could be avoided in asymptomatic patients [31]. Ngobesel et al. found that endoscopy was not meaningful in asymptomatic patients [32]. Urganci et al. reported that no pathological findings were detected in 53% of patients evaluated by endoscopy [33]. On the other hand, studies have shown that 70% of patients with severe oropharyngeal lesions did not have post-corrosive burns of the esophagus or stomach. Therefore, oropharyngeal injuries are not a reliable indicator of damage that may occur in the esophagus or stomach [34]. Contrary to this study, some studies have shown that the clinical manifestations of corrosive substance ingestion are a poor indicator of the degree and depth of esophageal or gastric injury and that signs and symptoms are not necessarily related to the severity of corrosive esophagitis [19,35,36]. They concluded that the absence of any clinical findings does not rule out serious esophageal or gastric injury. Consistent with the literature, few studies have confirmed the predictive value of laboratory tests for corrosive substance morbidity [20]. Similarly, in the study by Chen et al., leukocyte counts were useful for assessing the severity of esophageal injury but were shown to be of no benefit in predicting the resulting stricture of the esophagus. Furthermore, C-reactive protein was also shown to be an unhelpful parameter [37]. In our study, similar to other literature, neutrophil levels were significantly higher (p = 0.016) and lymphocyte levels were lower (p = 0.007) in the symptomatic group. Consequently, NLR was significantly higher in the symptomatic group (p = 0.002). A sensitivity of 61.1% and a specificity of 90.3% were obtained for NLR. Similarly, PLR (p = 0.006), SII (p = 0.004), SIRI (p = 0.020), and PIV (p = 0.019) values were also found to be significantly higher in the symptomatic group. The likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR = 6.66; 95% CI: 1.04–42.9; p = 0.046). Furthermore, the risk of symptom development in patients with NLR ≥ 2.15 was significantly higher compared to those with low NLR levels (OR = 17.6; 95% CI: 5.6–55.5; p < 0.001). Similar to the study conducted by Elawady et al. 2017, post-hoc analyses in our study showed that hemoglobin levels were significantly higher in the detergents group (p = 0.037) and the bleach and other corrosive substances group (p = 0.017) compared to the drain openers and descalers group [38]. This assessment suggests that blood parameter values are a good indicator of the severity of corrosive esophagitis and may assist in predicting mortality and morbidity rates. Conclusion The most important way to prevent complications from corrosive burns is to implement temporary measures to prevent ingestion. However, esophageal and gastric burns resulting from corrosive substance ingestion remain a serious cause of morbidity and mortality. In developing countries where endoscopy and other techniques for early assessment of severity are risky, unavailable, or difficult to obtain, careful monitoring of signs and symptoms along with laboratory data is recommended. Preventive measures such as safe packaging, labeling, keeping out of sight and reach of children, and lower caustic concentrations will always remain the primary recommendations. Our study suggests that blood parameter values are a good indicator of the severity of corrosive esophagitis and may help predict the degree of mortality and morbidity. This prevents unnecessary endoscopies as an invasive method. However, more studies with a larger number of patients and longer follow-up periods are needed. Declarations Ethics approval and consent to participate : This retrospective study was approved by the Institutional Ethics Committee of Hitit University Faculty of Medicine (date: 03.01.2024, decision number: 2023-22). Data availability: Data can be obtained by contacting the corresponding author. Competing interests : The authors do not have any conflict of interests. Funding: None Author contributions: All authors contributed to the study conception and design. All authors read and approved the final manuscript. Hİ: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. GD: Conceptualization, Data curation, Methodology, Resources, Validation, Writing – review & editing. MM: Conceptualization, Formal analysis, Methodology, Validation, Writing – review & editing. NÇ: Conceptualization, Methodology, Validation, Writing – review & editing. ÇEA: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. References Gad SE, Lye. In: Wexler P, editor. Encyclopedia of Toxicology . 3rd ed. London: Elsevier; 2014. p. 123-5. Temiz A. Caustic Ingestion. In: Baerg J, editor. Pediatric and Neonatal Surgery . London: Intech Open; 2017. p. 127-60. Denizbaşı A. Korozif madde alan hastaların acil tıpta yönetimi [Management of patients with corrosive substance ingestion in the emergency medicine]. Anatolian Journal of Emergency Medicine . 2020;3(1):27-30. Çelikkaya ME, Atıcı A, El Ç, Akçora B. A common public health problem: corrosive ingestion in children. İzmir Dr. Behçet Uz Çocuk Hast Dergisi . 2018;8(3):184-8. Aydın E, Khanmammadova N, Aslanyürek B, Urgancı N, Usta M, Parlak A, et al. A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children. Pediatr Surg Int . 2024;40:20. doi:10.1007/s00383-023-05602- Ateş U, Göllü G, Ergün E, Serttürk F, Jafarov A, Bülbül M, et al. Corrosive Substance Ingestion: When to Perform Endoscopy? J Paediatr Child Health . 2025 Jun;61(6):967-73. doi:10.1111/jpc.70064 Kluger Y, Ishay IB, Sartelli M, et al. Caustic ingestion management: World Society of Emergency Surgery preliminary survey of expert opinion. World J Emerg Surg . 2015;10:48. doi:10.1186/s13017-015-0043-4 Aydın E, Özcan R, Emre Ş, et al. Corrosive ingestion in pediatric age group: analysis of 681 patients. Turk Assoc Pediatr Surg . 2012;26:26-31. doi:10.5222/JTAPS.2012.026 Karaman İ, Koç O, Karaman A, et al. Evaluation of 968 children with corrosive substance ingestion. Indian J Crit Care Med . 2015;19(12):714-718. doi:10.4103/0972-5229.171377 Tang LJ, Lou JG, Zhao H, Peng KR, Yu JD. Zhongguo Dang Dai Er Ke Za Zhi Clinical analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children. Dang Dai Er Ke Za Zhi . 2023;25(12):1265-69. doi:10.7499/j.issn.1008-8830.2305106 Morilla Fernandez JA, Egea Valenzuela J, Fernandez Llamas T, Melero Nicolas B, Navalon Rubio M, Gil Ortega D ,et al.. The role of endoscopy in caustic ingestion in the pediatric population: experience in a tertiary center. Gaudreault P, Parent M, McGuigan MA, Chicoine L, Lovejoy FH. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71:767‑70. Leape LL, Ashcraft KW, Scarpelli DG, Holder TM. Hazard to healthn liquid lye. N Engl J Med . 1971;284:578‑581. doi:10.1056/nejm197103182841104. Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean region: a systematic review. BMC Public Health . 2010;10:83. doi:10.1186/1471‑2458‑10‑83. Predescu D, Achim F, Constantinoiu S, et al. From caustic stenosis to esophageal cancer: a challenging evolution‑narrative review. Chirurgia (Bucur ). 2024;119(5):515‑32. doi:10.21614/chirurgia.3050. Sanchez‑Ramirez CA, Larrosa‑Haro A, Vasquez‑Garibay EM, Macias‑Rosales R. Socio‑demographic factors associated with caustic substance ingestion in children and adolescents. Int J Pediatr Otorhinolaryngol . 2012;76(2):253‑6. de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30‑year review. Int J Pediatr Otorhinolaryngol . 2001;57(3):203‑11. Betalli P, Falchetti D, Giuliani S, et al. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. Gastrointest Endosc. 2008;68:434‑439. doi:10.1016/j.gie.2008.02.016. Boskovic A, Stankovic I. Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children? Eur J Gastroenterol Hepatol . 2014;26(5):499‑503 Kaya M, Ozdemir T, Sayan A, Arıkan A. The relationship between clinical findings and esophageal injury severity in children with corrosive agent ingestion . Ulus Travma Acil Cerrahi Derg. 2010;16(6):537‑40. Suzen A, Alev S, et al. Türkiye Güneybatısı’ndan retrospektif çalışma: koroziv madde alımına minimal invaziv yaklaşım. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi . 2021;82:80‑83. Radhakrishna V, Kumar N, Gadgade BD, Vasudev RB, Alladi A. Sequelae of corrosive injury in children: an observational study. J Indian Assoc Pediatr Surg . 2022;27(4):435‑40. doi:10.4103/jiaps.jiaps_133_21. Badiu Tisa I, Pepelea L, Pirvan A, Lupan I, Samasca G, Bordea A. Endoscopic grading as a predictor to develop strictures in corrosive esophagitis in children. J Clin Med. 2023;12(4):1699. doi:10.3390/jcm12041699. Quitadamo P, di Lauri A, Albano R, Laudadio V, Gragnaniello P, Puoti MG, et al. The effects of liquid bleach ingestion on children's esophageal and gastric mucosa. J Pediatr Gastroenterol Nutr. 2025;81(1):11‑7. doi:10.1002/jpn3.70063. Chibishev A, Simonovska N, Shikole A. Post‑corrosive injuries of upper gastrointestinal tract. Contrib Sec Biol Med Sci . 2010;31(1):45‑52. doi:10.1002/ejsp.2181. Gorman RL, Khin‑Maung‑Gyi MT, Klein‑Schwartz W, et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med . 1992;10:189‑94. doi:10.1016/0735‑6757(92)90206‑D. Irlayıcı FI, Elmas A, Akcam M. Corrosive substance ingestion in children: clinical features, management and outcomes in a tertiary care setting. Eur J Pediatr . 2025;184(9):549. doi:10.1007/s00431‑025‑06402‑3. Akbay‑Öntürk Y, Uçar B. Eskişehir bölgesinde çocukluk çağı zehirlenmelerinin retrospektif değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi . 2003;46:103‑13. Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenoscopy necessary for all caustic ingestions? J Pediatr Gastroenterol Nutr . 2001;32(1):50‑3. Di Nardo G, Betalli P, Illiceto MT, et al. Caustic ingestion in children: a year's experience in 3 Italian referral centers. J Pediatr Gastroenterol Nutr . 2020;71(1):19‑22. JA Haller HG Andrews JJ White 1971 Pathophysiology and management of acute corrosive burns of the esophagus: results of treatment in 285 children J Pediatr Surg 6 578 584 . Ngobese A, Govender S, Peer N , Sheik‑Gafoor MH. Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients Pediatric Surgery International (2022)38:505–512 Urganci N, Usta M, Kalyoncu D, Demirel E. Corrosive substance ingestion in children. Indian J Pediatr . 2014;81(7):675‑79. Chibishev A, Pereska Z, Chibisheva V, et al. Corrosive poisonings in adults. Mater Sociomed. 2012; 24(2):125‑30. Lupa M, Magne J, Guarisco JL, Amedee R. Update on the diagnosis and treatment of caustic ingestion. Ochsner J. 2009;9:54‑59. doi:10.1016/j.ad.2014.06.007. Sudarsi B, Rani K, Siddeswari R, et al. Clinical and endoscopic study of upper GI manifestation in corrosive acid ingestion . Int J Sci Res Publ . 2015;5(2):1‑5. Chen TY , Ko SF, Chuang JH,Kuo HW,Tiao MM. Predictors of esophageal stricture in children with unintentional ingestion of caustic agents Chang Gung Med J 2003 Apr;26(4):233-9. Elawady EH, Hafiz RN, Nasr MA. The prognostic value of some initial clinical manifestations and biochemical parameters for evaluating the outcome in corrosives‑poisoned children. Zagazig J Forensic Med Toxicol . 2017;15(1):1‑10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Mar, 2026 Reviews received at journal 03 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviews received at journal 21 Jan, 2026 Reviewers agreed at journal 11 Jan, 2026 Reviewers invited by journal 09 Jan, 2026 Submission checks completed at journal 07 Jan, 2026 First submitted to journal 07 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8087399","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":572831973,"identity":"9375d6b0-5554-42bf-8a77-1dbae3db73f1","order_by":0,"name":"Hülya İpek","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYDCCAzwMDA8YGBj7GRjYSNCSANQys4FkLRsOEKuF7/bZYxKJbXaym28kP3vwoYJBnl/sAH4tkufy0oBako233UgzN5xxhsFw5uwE/FoMzvCYAbUwJ267kWAmzdvGkGBwmzgt9YmbZ6R/I0nL4cQNEjlE2iJ5hsfYIuHcceMZZ96USc44I0HYL3xneAxvfCirlu1vT98m8aHCRp5fmoAWMGAExYgAWKUEEcrB4A8Q8x8gVvUoGAWjYBSMNAAAEVlFQLyNdMwAAAAASUVORK5CYII=","orcid":"","institution":"Hitit University","correspondingAuthor":true,"prefix":"","firstName":"Hülya","middleName":"","lastName":"İpek","suffix":""},{"id":572831974,"identity":"f93b7c1b-dd11-4850-9734-4bbd3885a7f3","order_by":1,"name":"Gül Doğan","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Gül","middleName":"","lastName":"Doğan","suffix":""},{"id":572831975,"identity":"2fea4d60-e57a-4725-8aaf-23e89bac2031","order_by":2,"name":"Mehmet Metin","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Metin","suffix":""},{"id":572831976,"identity":"895dde03-46ca-47ec-9a5e-8865f03ee0d4","order_by":3,"name":"Nurcan Çoşkun","email":"","orcid":"","institution":"Hitit University Erol Olçok Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nurcan","middleName":"","lastName":"Çoşkun","suffix":""},{"id":572831977,"identity":"64c1b9bf-f46c-466f-9925-6318c9b9409b","order_by":4,"name":"Çağatay Evrim Afşarlar","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Çağatay","middleName":"Evrim","lastName":"Afşarlar","suffix":""}],"badges":[],"createdAt":"2025-11-11 13:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8087399/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8087399/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100400149,"identity":"bbf669d4-35aa-4878-ad50-46ac94016d94","added_by":"auto","created_at":"2026-01-16 11:57:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135783,"visible":true,"origin":"","legend":"","description":"","filename":"KOROZF.docx","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/e9cc33d17251995f1c3b7229.docx"},{"id":100399517,"identity":"d1a96797-3f91-4eb8-8b7b-a20409090e5d","added_by":"auto","created_at":"2026-01-16 11:57:10","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8028,"visible":true,"origin":"","legend":"","description":"","filename":"2f1729adfe1347be8dbcd15aae3b1038.json","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/76090f655a12069efea43af1.json"},{"id":100400773,"identity":"a4645a49-d404-4d32-b8be-295246319359","added_by":"auto","created_at":"2026-01-16 11:58:25","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":154161,"visible":true,"origin":"","legend":"","description":"","filename":"tablolarkorozif.docx","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/bda5164d089a661214c92229.docx"},{"id":100400606,"identity":"8ee49702-aa0a-4339-a280-e78c4d9973a2","added_by":"auto","created_at":"2026-01-16 11:58:19","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80537,"visible":true,"origin":"","legend":"","description":"","filename":"2f1729adfe1347be8dbcd15aae3b10381enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/2b59e2f0774a83dd80ea39b8.xml"},{"id":100400691,"identity":"e7720d73-2626-4e14-9b3c-aad57143bc62","added_by":"auto","created_at":"2026-01-16 11:58:23","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":132250,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/5e9cec9370995ecaeb60ae32.jpeg"},{"id":100400384,"identity":"9a937417-186c-4650-90b5-64d9be469ef8","added_by":"auto","created_at":"2026-01-16 11:58:07","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33016,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/aed3c65da22ea47b08764d0c.png"},{"id":100400645,"identity":"87af28b3-c3e8-445b-ae1c-1d306bbbaf94","added_by":"auto","created_at":"2026-01-16 11:58:21","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77652,"visible":true,"origin":"","legend":"","description":"","filename":"2f1729adfe1347be8dbcd15aae3b10381structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/4ccdfd32d332a329b1c69df3.xml"},{"id":100399633,"identity":"1b485c55-a980-43ab-9acb-103fcfbae6d1","added_by":"auto","created_at":"2026-01-16 11:57:21","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90145,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/c533e1926a86b2b70a6790ce.html"},{"id":100400795,"identity":"4423b379-9028-4956-a082-c60cc5d74b28","added_by":"auto","created_at":"2026-01-16 11:58:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":225276,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot demonstrates the distributions of NLR and SII along with optimal cutoff points in symptom groups.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/24e36213ab51f11bf937ccc7.png"},{"id":100412156,"identity":"c8c46995-a4bb-44eb-8732-18fa16f46aea","added_by":"auto","created_at":"2026-01-16 13:13:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8087399/v1/2f602a98-dc99-4e32-ba07-fd7aae64ea6e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A New Biomarker in the Diagnosis of Pediatric Corrosive Esophagitis: Pan-Immune Inflammatory Score and Systemic Inflammatory Index: Can esophagoscopy be omitted in asymptomatic patients?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLesions formed in the esophagus as a result of ingesting corrosive substances (acid or alkali) in liquid or solid form are called corrosive esophagitis [1,2]. Such accidents are common in the pediatric age group and constitute a significant health problem in our country. Corrosive substances are divided into two main groups according to their chemical content: basic and acidic. Acidic substances cause coagulation necrosis in the affected tissue, resulting in more superficial damage. Basic substances, on the other hand, cause liquefactive necrosis in the tissue, leading to deeper and more extensive damage [3,4]. Full-thickness burns, perforation, and stricture development, especially in the thoracic esophagus, cause significant morbidity and mortality. Long-term complications include esophageal stricture development and gastrointestinal morbidity risk, which varies between 7\u0026ndash;25% [5,6].\u003c/p\u003e \u003cp\u003eThe unresolved debate surrounding the management of corrosive substance ingestion poses a significant problem for both patients and healthcare systems. The clinical management of corrosive substance ingestion is directly related to the extent of damage caused and the development of strictures. Current guidelines recommend endoscopic evaluation within 24\u0026ndash;48 hours after corrosive substance exposure [7,8]. However, some researchers argue that endoscopy may yield a high rate of false-negative results and should only be performed according to specific criteria [9,10,11]. The current literature highlights the mismatch between symptom severity and the severity of esophageal injury as a significant clinical challenge. Determining the patient's prognosis based on the chemical properties of the ingested corrosive substance is often difficult [12]. Therefore, it is challenging for clinicians to quickly assess the patient's current condition based on the various characteristics of the ingested product. This situation requires a reliable, easy, rapid, and reproducible biomarker to diagnose the presence and severity of burns after suspected caustic ingestion, as there is no consensus on patient management. Recently, parameters obtained from complete blood counts (CBC) have attracted attention as cost-effective and accessible biomarkers for assessing systemic inflammation in various diseases. A complete blood count is easy to perform, inexpensive, and provides information about morphological parameters (white blood cell count, lymphocyte count, neutrophil count, monocyte count, platelet count, and mean platelet volume). The combined ratios of these parameters are used as inflammation indices and assist in the diagnosis, progression, and risk assessment of many diseases. The systemic immune-inflammation (SII) index (calculated as platelet count \u0026times; NLR) is increasingly used to evaluate the immune response, along with NLR and PLR. A review of the literature revealed no studies evaluating NLR, PLR, SII, and SIRI together with PIV in pediatric patients who ingested corrosive substances. In our study, we aimed to evaluate the relationship between NLR, PLR, SII levels and symptoms in patients who ingested corrosive substances, to assess their effect on prognosis and to evaluate the potential of predicting the severity of esophageal burns using complete blood count parameters. Specifically, by analyzing the prognostic values of markers such as the Systemic Immune-Inflammation Index (SII), SIRI, and PIV score, we aimed to identify alternative diagnostic approaches that could reduce the necessity for endoscopy, an invasive procedure for pediatric patients. The limitations of our study are that it is retrospective and single-center.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eAfter obtaining informed consent from all legal guardians and/or children and approval from Institutional Ethics Committee of Hitit University Faculty of Medicine (date: 03.01.2024, decision number: 2023-22), between December 2018\u0026ndash;2023, 213 pediatric cases (under 18 years of age) treated at our hospital as outpatients or inpatients for corrosive esophagitis were retrospectively analyzed for correlations between gender, age, types of corrosive substances, symptoms, physical examination findings, and patients' blood values. The study recorded demographic data (age and gender) and laboratory parameters (hemoglobin, WBC, monocytes, neutrophils, lymphocytes, platelets, and albumin) for each patient and calculated the following inflammation indices derived from these data: NLR\u0026thinsp;=\u0026thinsp;Neutrophil/Lymphocyte, PLR\u0026thinsp;=\u0026thinsp;Platelet/Lymphocyte, SII = (Platelet \u0026times; Neutrophil)/Lymphocyte, SIRI = (Neutrophil \u0026times; Monocyte)/Lymphocyte, PIV = (Neutrophil \u0026times; Monocyte \u0026times; Platelet)/Lymphocyte. Patients were classified in three groups according to the type of substance they ingested: detergents, bleach and other corrosive substances, and drain cleaners and limescale removers. In addition, two subgroups were formed according to the presence of symptoms: symptomatic and asymptomatic.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA, License: Hitit University). Graphs were produced using the ggplot2 library in R Studio version 2023.06.2 (R Foundation for Statistical Computing, Vienna, Austria; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.r-project.org\u003c/span\u003e\u003cspan address=\"https://www.r-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Descriptive statistics for categorical variables were presented as frequency (n) and percentage (%). Differences in proportions between groups were assessed using the chi-square test. Continuous variables were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) when they met the assumption of normal distribution, and as median (Q1\u0026ndash;Q3) when they did not. Kolmogorov-Smirnov and Shapiro-Wilks tests, histograms, and Q-Q plots were used to assess the normal distribution of numerical data. Variance homogeneity was tested using the Levene test. For comparisons between two independent groups, Student's t-test was used when parametric assumptions were met, and the Mann-Whitney U test was used when they were not met. When parametric assumptions were met in the comparison of three or more independent groups, one-way ANOVA was applied; when they were not met, the Kruskal-Wallis test was applied. Dunn-Bonferroni post hoc pairwise comparisons were performed in cases where significant differences were detected with the Kruskal-Wallis test.\u003c/p\u003e \u003cp\u003eROC analysis was performed to evaluate the performance of inflammation indices in predicting symptom presence. ROC curves, AUC values, and 95% confidence intervals were calculated. AUC values were interpreted as excellent (0.9\u0026ndash;1), good (0.8\u0026ndash;0.9), moderate (0.7\u0026ndash;0.8), poor (0.6\u0026ndash;0.7), and very poor (0.5\u0026ndash;0.6). The optimal cut-off points in the ROC analysis were determined using the Youden index; sensitivity and specificity rates were calculated for these values. In addition, univariate and multivariate binary logistic regression analyses were performed to evaluate the effect of the new categorical variables created according to the determined optimal cut-off values on symptom prediction. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each statistically significant parameter. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant in all tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 213 patient records were analyzed in the study. Of the patients, 106 (49.8%) were female and 107 (50.2%) were male. When the distribution was investigated according to the groups of ingested substances, 68 patients (31.9%) ingested detergent, 98 patients (46%) ingested bleach and corrosive substances, and 47 patients (22.1%) ingested drain cleaner and limescale remover. The rate of patients without symptoms was 91.5% (n\u0026thinsp;=\u0026thinsp;195), while the rate of patients who developed symptoms was 8.5% (n\u0026thinsp;=\u0026thinsp;18). The mean age in the entire sample was 5.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98 years (min\u0026ndash;max: 0\u0026ndash;18). The average length of stay was 0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67 days, and the longest length of stay was determined to be 35 days.\u003c/p\u003e \u003cp\u003eComparative findings of demographic characteristics, laboratory parameters, and inflammation indices between the study groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No significant differences were found between the ingested substance groups in terms of gender distribution, age, length of stay, monocytes, neutrophils, lymphocytes, platelets, albumin, WBC, NLR, PLR, SII, SIRI, and PIV (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, a significant difference was found between the groups in terms of hemoglobin levels (p\u0026thinsp;=\u0026thinsp;0.014). Post-hoc analyses showed that hemoglobin values were significantly higher in the detergents group (p\u0026thinsp;=\u0026thinsp;0.037) and the bleach and other corrosive substances group (p\u0026thinsp;=\u0026thinsp;0.017) as compared to the drain openers and lime removers groups.\u003c/p\u003e \u003cp\u003eThe findings obtained from comparisons based on symptom presence are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. While neutrophil levels were significantly higher (p\u0026thinsp;=\u0026thinsp;0.016), lymphocyte levels were lower (p\u0026thinsp;=\u0026thinsp;0.007) in the symptomatic group. Consequently, NLR was markedly elevated in the symptomatic group (p\u0026thinsp;=\u0026thinsp;0.002). Similarly, PLR (p\u0026thinsp;=\u0026thinsp;0.006), SII (p\u0026thinsp;=\u0026thinsp;0.004), SIRI (p\u0026thinsp;=\u0026thinsp;0.020), and PIV (p\u0026thinsp;=\u0026thinsp;0.019) values were also significantly higher in the symptomatic group. No significant differences were observed between the groups in terms of gender, age, length of stay, monocytes, hemoglobin, platelets, albumin, and WBC (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe performance of inflammation indices in predicting symptom development was evaluated by ROC analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). According to the ROC results, the highest AUC value for distinguishing symptom presence was calculated for NLR (AUC\u0026thinsp;=\u0026thinsp;0.723; 95% CI: 0.557\u0026ndash;0.888). Considering the optimal cutoff point of 2.15 determined by the Youden index for NLR, 61.1% sensitivity and 90.3% specificity were obtained. The PLR (AUC\u0026thinsp;=\u0026thinsp;0.695), SII (AUC\u0026thinsp;=\u0026thinsp;0.705), SIRI (AUC\u0026thinsp;=\u0026thinsp;0.666), and PIV (AUC\u0026thinsp;=\u0026thinsp;0.667) indices also showed meaningful performance in symptom differential diagnosis. While specificity values ranged from 88% to 95% for these parameters, sensitivity values ranged from 55% to 78%. The distributions of NLR and SII, which had AUC values greater than 0.700 in the symptom groups, are shown in Fig.\u0026nbsp;1 along with the optimal cut-off points. The findings of the logistic regression analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. In univariate analyses, gender and age had no significant effect on symptoms (p\u0026thinsp;=\u0026thinsp;0.638 and p\u0026thinsp;=\u0026thinsp;0.612, respectively). Compared to the detergent group, the risk of symptom development was significant at the p\u0026thinsp;=\u0026thinsp;0.10 level in the bleach and corrosive substance group (p\u0026thinsp;=\u0026thinsp;0.069). However, the likelihood of symptom development in the drain openers and descalers group was not significantly different from that in the detergent group (p\u0026thinsp;=\u0026thinsp;0.111). The risk of symptom development in patients with NLR\u0026thinsp;\u0026ge;\u0026thinsp;2.15 was significantly higher compared to those with low NLR levels (OR\u0026thinsp;=\u0026thinsp;14.6; 95% CI: 5.05\u0026ndash;41.9; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although gender and age were not statistically significant in the univariate model, they were included in the multivariate model to refine the effect. According to the multivariate model findings, the likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR\u0026thinsp;=\u0026thinsp;6.66; 95% CI: 1.04\u0026ndash;42.9; p\u0026thinsp;=\u0026thinsp;0.046). Furthermore, the risk of symptom development in patients with NLR\u0026thinsp;\u0026ge;\u0026thinsp;2.15 was significantly higher compared to those with low NLR levels (OR\u0026thinsp;=\u0026thinsp;17.6; 95% CI: 5.6\u0026ndash;55.5; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The explanatory power of the multiple logistic regression model was Nagelkerke R\u0026sup2;=0.305, and the classification accuracy was calculated as 92.5%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographic, laboratory parameters, and inflammation indices between the research groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDetergents\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBleach and Other Corrosive Substances (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDrain Openers and Lime Removers (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePost-hoc \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (53.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.736\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (53.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (46.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1\u0026ndash;12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.928\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of Hospital Stay (day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.187\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonocyte\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.813\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.8 (12.5\u0026ndash;13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7 (12.5\u0026ndash;13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5 (12.3\u0026ndash;12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2: 1.000\u003c/p\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;3: 0.037\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e2\u0026ndash;3: 0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeutrophil\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.331\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLymphocyte\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.944\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307.8\u0026thinsp;\u0026plusmn;\u0026thinsp;66.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e309.6\u0026thinsp;\u0026plusmn;\u0026thinsp;59.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e305\u0026thinsp;\u0026plusmn;\u0026thinsp;71.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.922\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (41\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (41-45.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (41\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.831\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.444\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.05 (0.73\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (0.68\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.94 (0.68\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.367\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.02 (43.22\u0026ndash;76.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.21 (38.05\u0026ndash;84.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.17 (39.25\u0026ndash;71.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.668\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSII\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304.1 (210.9-497.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321 (190.7-483.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e296.4 (186.8 -400.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.371\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSIRI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.92 (1.08\u0026ndash;3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.77 (0.95\u0026ndash;3.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.49 (0.97\u0026ndash;2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.571\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePIV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e568.8 (343.1\u0026ndash;1007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e502.9 (260.9\u0026ndash;963.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e454 (262.2\u0026ndash;773)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.534\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003eChi-Square with n (%)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003eOne-way ANOVA with mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ec\u003c/sup\u003eKruskal wallis test followed Dunn-Bonferroni post-hoc tests with median (Q1-Q3)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eF: Female, M: Male, Hb: Hemoglobin, PLT: platelets, WBC: White Blood Cell, NLR: Neutrophil-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammatory Response Index, PIV: Pan-Immune-Inflammation Value\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistical comparison of demographic characteristics, laboratory parameters, and inflammation indices among symptom groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsymptomatic (n\u0026thinsp;=\u0026thinsp;195)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSymptomatic (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (50.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.637\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (49.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of Hospital Stay (day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0 .28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.267\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonocyte\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.710\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7 (12.4\u0026ndash;13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.65 (12.5\u0026ndash;13.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.992\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeutrophil\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003csup\u003e\u003cb\u003ed\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLymphocyte\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003csup\u003e\u003cb\u003ed\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307\u0026thinsp;\u0026plusmn;\u0026thinsp;63.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e318.7\u0026thinsp;\u0026plusmn;\u0026thinsp;77.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.462\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (41\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.5 (41\u0026ndash;46.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.741\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.605\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.68\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.84 (0.83\u0026ndash;3.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003ee\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.3 (39.6\u0026ndash;77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.5 (60.8\u0026ndash;146.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003csup\u003e\u003cb\u003ee\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSII\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300.3 (199\u0026ndash;453.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e785.8 (214.1\u0026ndash;1282)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003csup\u003e\u003cb\u003ee\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSIRI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.72 (0.97\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.04 (0.99\u0026ndash;8.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003csup\u003e\u003cb\u003ee\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePIV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e498.1 (273\u0026ndash;839.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1469.4 (202.9\u0026ndash;2632)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003csup\u003e\u003cb\u003ee\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003eChi-square test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ed\u003c/sup\u003eStudent\u0026rsquo;s t test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ee\u003c/sup\u003eMann-Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eF: Female, M: Male, Hb: Hemoglobin, PLT: platelets, WBC: White Blood Cell, NLR: Neutrophil-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammatory Response Index, PIV: Pan-Immune-Inflammation Value\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of ROC analysis for inflammation indices in predicting symptoms, with cut-off values and corresponding sensitivity and specificity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCut-off\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower Bound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper Bound\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e%61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e%90.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e%77.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e%63.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSII\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e738.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e%61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e%92.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSIRI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e%55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e%94.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePIV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e%61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e%88.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNLR: Neutrophil-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammatory Response Index, PIV: Pan-Immune-Inflammation Value, AUC: Area Under Curve, CI: Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of univariate and multivariate binary logistic regression analyses to determine the effect of risk factors on predicting symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (CI 95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (CI 95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Male vs. female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubstance Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleach and other corrosive substances vs. detergents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.069\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.17 (0.89\u0026ndash;19.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.27 (0.83\u0026ndash;22.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrain openers and lime removers vs. detergents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.93 (0.73\u0026ndash;21.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.66 (1.04\u0026ndash;42.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(\u0026ge;\u0026thinsp;2.15 vs\u0026thinsp;\u0026lt;\u0026thinsp;2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6 (5.05\u0026ndash;41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.6 (5.6\u0026ndash;55.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMultivariate model:\u003c/p\u003e \u003cp\u003eNagelkerke R Square\u0026thinsp;=\u0026thinsp;0.305, Classification accuracy: 92.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues below \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were shown bold\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eOR: Odds ratio, CI: Confidence interval, NLR: Neutrophil-to-Lymphocyte Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough corrosive substance ingestion is a rare health problem in developed countries due to the safety measures taken, it remains a significant cause of morbidity and mortality in developing countries [13]. Injuries related to corrosive substance ingestion are particularly common in the childhood age group. Although there has been a marked decrease in incidence in the United States (US) since the 1960s due to legal regulations on hazardous household chemicals, it is reported that there are between 5,000 and 15,000 cases of corrosive substance ingestion annually [14,15]. Although there are no definitive recorded data for Turkey, the annual number of cases is estimated to be between 3,000 and 5,000 [16]. The accidental ingestion of products with high chemical content, such as household cleaners, bleach, limescale removers, and grease removers, by children due to carelessness or inadequate safety measures is considered a common and preventable health problem in pediatric surgery clinics. Leaving such products exposed during cleaning further increases the likelihood of ingestion [17].\u003c/p\u003e \u003cp\u003eWhen the ingsted substances are overviewed, it is obvious that most of these substances are poured into cups by parents during cleaning and forgotten in an easily accessible place. In addition, open types that are filled into different bottles instead of factory-sealed boxes are more frequently preferred and perceived by children as drinkable. Although there are series in the literature showing that symptoms are not effective in determining esophageal damage, there are also series showing that the degree of damage and future strictures are always related to symptoms and signs. The current literature indicates that the mismatch between the severity of symptoms and the severity of esophageal damage is a significant clinical challenge [18]. Furthermore, determining the patient's prognosis based on the chemical properties of the corrosive substance is often difficult. The clinical management of corrosive substance ingestion is directly related to the degree of damage and the development of strictures. Current guidelines recommend endoscopic evaluation within 24\u0026ndash;48 hours after exposure [19,20]. However, some researchers argue that endoscopy may yield a high rate of false-negative results and should only be performed according to specific criteria [21,22]. In one study, 968 pediatric patients were evaluated over a 22-year period at a center where endoscopy was not routinely performed, and it was found that only 13.5% of all patients developed long-term esophageal stricture. One disadvantage of endoscopy is that it cannot detect transmural or submucosal tissue damage. For example, a study in which physicians at a tertiary center performed endoscopy to evaluate the esophagus after corrosive substance ingestion showed that 56.9% of endoscopies were normal [23]. Consequently, many studies in the literature report unnecessary endoscopy rates between 60% and 80% [24]. On the other hand, there is no reliable predictor to determine the presence and severity of corrosive esophagitis prior to endoscopic evaluation, including the presence of oropharyngeal injuries [25, 26]. Therefore, since symptoms and physical examination cannot be relied upon to confirm esophageal burns after caustic substance ingestion, most patients are either missed or subjected to unnecessary endoscopies that should not be performed.\u003c/p\u003e \u003cp\u003eConsequently, there is a growing need for a reliable, easy, rapid, and reproducible biomarker that can predict the presence and severity of esophageal damage after exposure to corrosive substances. A review of the literature reveals no studies evaluating NLR, PLR, SII, SIRI, and PIV scores together in pediatric patients who have ingested corrosive substances. In our study, we aimed to investigate the effect on prognosis by evaluating whether there is a relationship between NLR, PLR, SII, SIRI, and PIV levels and symptoms in our patients who ingested corrosive substances. We also aimed to contribute to the development of a rapid and low-cost diagnostic approach in clinical management by investigating the usability of biomarkers as an alternative to endoscopy, which is an invasive procedure. When children admitted to the hospital due to corrosive substance ingestion were evaluated by age group, the mean age in our study was found to be 5.35, similar to the literature. It was observed that the ingested substances were mostly cleaning agents sold openly [27]. The most common complaints among patients presenting to the hospital were vomiting and hypersalivation. Physical examination findings revealed redness inside and around the mouth. Akbay and \u0026Ouml;ner et al., as well as Bi\u0026ccedil;er and colleagues [28], reported that hyperemia and edema of the oral mucosa were the most common physical findings in children. Our results are similar to those reported in the aforementioned studies. Gupta et al. also reported that endoscopic examination of asymptomatic patients revealed no pathological findings and that advanced injuries were only detected in patients with severe symptoms [29]. In light of the findings obtained in the multicenter study conducted by Di Nardo et al., they recommended that only symptomatic patients undergo endoscopy [30]. Similarly, a multicenter study conducted in the United States on 285 children concluded that the incidence of significant injuries without any signs or symptoms was very low and that endoscopy could be avoided in asymptomatic patients [31]. Ngobesel et al. found that endoscopy was not meaningful in asymptomatic patients [32]. Urganci et al. reported that no pathological findings were detected in 53% of patients evaluated by endoscopy [33]. On the other hand, studies have shown that 70% of patients with severe oropharyngeal lesions did not have post-corrosive burns of the esophagus or stomach. Therefore, oropharyngeal injuries are not a reliable indicator of damage that may occur in the esophagus or stomach [34]. Contrary to this study, some studies have shown that the clinical manifestations of corrosive substance ingestion are a poor indicator of the degree and depth of esophageal or gastric injury and that signs and symptoms are not necessarily related to the severity of corrosive esophagitis [19,35,36]. They concluded that the absence of any clinical findings does not rule out serious esophageal or gastric injury.\u003c/p\u003e \u003cp\u003eConsistent with the literature, few studies have confirmed the predictive value of laboratory tests for corrosive substance morbidity [20]. Similarly, in the study by Chen et al., leukocyte counts were useful for assessing the severity of esophageal injury but were shown to be of no benefit in predicting the resulting stricture of the esophagus. Furthermore, C-reactive protein was also shown to be an unhelpful parameter [37]. In our study, similar to other literature, neutrophil levels were significantly higher (p\u0026thinsp;=\u0026thinsp;0.016) and lymphocyte levels were lower (p\u0026thinsp;=\u0026thinsp;0.007) in the symptomatic group. Consequently, NLR was significantly higher in the symptomatic group (p\u0026thinsp;=\u0026thinsp;0.002). A sensitivity of 61.1% and a specificity of 90.3% were obtained for NLR. Similarly, PLR (p\u0026thinsp;=\u0026thinsp;0.006), SII (p\u0026thinsp;=\u0026thinsp;0.004), SIRI (p\u0026thinsp;=\u0026thinsp;0.020), and PIV (p\u0026thinsp;=\u0026thinsp;0.019) values were also found to be significantly higher in the symptomatic group. The likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR\u0026thinsp;=\u0026thinsp;6.66; 95% CI: 1.04\u0026ndash;42.9; p\u0026thinsp;=\u0026thinsp;0.046). Furthermore, the risk of symptom development in patients with NLR\u0026thinsp;\u0026ge;\u0026thinsp;2.15 was significantly higher compared to those with low NLR levels (OR\u0026thinsp;=\u0026thinsp;17.6; 95% CI: 5.6\u0026ndash;55.5; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similar to the study conducted by Elawady et al. 2017, post-hoc analyses in our study showed that hemoglobin levels were significantly higher in the detergents group (p\u0026thinsp;=\u0026thinsp;0.037) and the bleach and other corrosive substances group (p\u0026thinsp;=\u0026thinsp;0.017) compared to the drain openers and descalers group [38]. This assessment suggests that blood parameter values are a good indicator of the severity of corrosive esophagitis and may assist in predicting mortality and morbidity rates.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe most important way to prevent complications from corrosive burns is to implement temporary measures to prevent ingestion. However, esophageal and gastric burns resulting from corrosive substance ingestion remain a serious cause of morbidity and mortality. In developing countries where endoscopy and other techniques for early assessment of severity are risky, unavailable, or difficult to obtain, careful monitoring of signs and symptoms along with laboratory data is recommended. Preventive measures such as safe packaging, labeling, keeping out of sight and reach of children, and lower caustic concentrations will always remain the primary recommendations. Our study suggests that blood parameter values are a good indicator of the severity of corrosive esophagitis and may help predict the degree of mortality and morbidity. This prevents unnecessary endoscopies as an invasive method. However, more studies with a larger number of patients and longer follow-up periods are needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: This retrospective study was approved by the Institutional Ethics Committee of Hitit University Faculty of Medicine (date: 03.01.2024, decision number: 2023-22).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003e Data can be obtained by contacting the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors do not have any conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e All authors contributed to the study conception and design. All authors read and approved the final manuscript. Hİ: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. GD: Conceptualization, Data curation, \u0026nbsp; Methodology, Resources, Validation, Writing \u0026ndash; review \u0026amp; editing. MM: Conceptualization, Formal analysis, Methodology, \u0026nbsp;Validation, Writing \u0026ndash; review \u0026amp; editing. N\u0026Ccedil;: Conceptualization, Methodology, \u0026nbsp; Validation, Writing \u0026ndash; review \u0026amp; editing. \u0026Ccedil;EA: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGad SE, Lye. In: Wexler P, editor. \u003cem\u003eEncyclopedia of Toxicology\u003c/em\u003e. 3rd ed. London: Elsevier; 2014. p. 123-5.\u003c/li\u003e\n \u003cli\u003eTemiz A. Caustic Ingestion. In: Baerg J, editor. \u003cem\u003ePediatric and Neonatal Surgery\u003c/em\u003e. London: Intech Open; 2017. p. 127-60.\u003c/li\u003e\n \u003cli\u003eDenizbaşı A. Korozif madde alan hastaların acil tıpta y\u0026ouml;netimi [Management of patients with \u0026nbsp; corrosive substance ingestion in the emergency medicine]. \u003cem\u003eAnatolian Journal of Emergency Medicine\u003c/em\u003e. 2020;3(1):27-30.\u003c/li\u003e\n \u003cli\u003e\u0026Ccedil;elikkaya ME, Atıcı A, El \u0026Ccedil;, Ak\u0026ccedil;ora B. A common public health problem: corrosive ingestion in children. \u003cem\u003eİzmir Dr. Beh\u0026ccedil;et Uz \u0026Ccedil;ocuk Hast Dergisi\u003c/em\u003e. 2018;8(3):184-8.\u003c/li\u003e\n \u003cli\u003eAydın E, Khanmammadova N, Aslany\u0026uuml;rek B, Urgancı N, Usta M, Parlak A, et al. A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children. \u003cem\u003ePediatr Surg Int\u003c/em\u003e. 2024;40:20. doi:10.1007/s00383-023-05602-\u003c/li\u003e\n \u003cli\u003eAteş U, G\u0026ouml;ll\u0026uuml; G, Erg\u0026uuml;n E, Sertt\u0026uuml;rk F, Jafarov A, B\u0026uuml;lb\u0026uuml;l M, et al. Corrosive Substance Ingestion: When to Perform Endoscopy? \u003cem\u003eJ Paediatr Child Health\u003c/em\u003e. 2025 Jun;61(6):967-73. doi:10.1111/jpc.70064\u003c/li\u003e\n \u003cli\u003eKluger Y, Ishay IB, Sartelli M, et al. Caustic ingestion management: World Society of Emergency Surgery preliminary survey of expert opinion. \u003cem\u003eWorld J Emerg Surg\u003c/em\u003e. 2015;10:48. doi:10.1186/s13017-015-0043-4\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAydın E, \u0026Ouml;zcan R, Emre Ş, et al. Corrosive ingestion in pediatric age group: analysis of 681 patients. \u003cem\u003eTurk Assoc Pediatr Surg\u003c/em\u003e. 2012;26:26-31. doi:10.5222/JTAPS.2012.026\u003c/li\u003e\n \u003cli\u003eKaraman İ, Ko\u0026ccedil; O, Karaman A, et al. Evaluation of 968 children with corrosive substance ingestion. \u003cem\u003eIndian J Crit Care Med\u003c/em\u003e. 2015;19(12):714-718. doi:10.4103/0972-5229.171377\u003c/li\u003e\n \u003cli\u003eTang LJ, Lou JG, Zhao H, Peng KR, Yu JD. Zhongguo Dang Dai Er Ke Za Zhi\u0026nbsp;Clinical \u0026nbsp; \u0026nbsp; \u0026nbsp; analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children.\u003c/a\u003e \u003cem\u003eDang Dai Er Ke Za Zhi\u003c/em\u003e. 2023;25(12):1265-69. doi:10.7499/j.issn.1008-8830.2305106\u003c/li\u003e\n \u003cli\u003eMorilla Fernandez JA, Egea Valenzuela J, Fernandez Llamas T, Melero Nicolas B, Navalon Rubio M, Gil Ortega D ,et al.. The role of endoscopy in caustic ingestion in the pediatric population: experience in a tertiary center.\u003c/li\u003e\n \u003cli\u003eGaudreault P, Parent M, McGuigan MA, Chicoine L, \u003cem\u003eLovejoy FH.\u003c/em\u003e Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71:767‑70.\u003c/li\u003e\n \u003cli\u003eLeape LL, Ashcraft KW, Scarpelli DG, Holder TM. Hazard to healthn liquid lye. \u003cem\u003eN Engl J Med\u003c/em\u003e. 1971;284:578‑581. doi:10.1056/nejm197103182841104.\u003c/li\u003e\n \u003cli\u003eOthman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean region: a systematic review. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2010;10:83. doi:10.1186/1471‑2458‑10‑83.\u003c/li\u003e\n \u003cli\u003ePredescu D, Achim F, Constantinoiu S, et al. From caustic stenosis to esophageal cancer: a challenging evolution‑narrative review. \u003cem\u003eChirurgia (Bucur\u003c/em\u003e). 2024;119(5):515‑32. doi:10.21614/chirurgia.3050.\u003c/li\u003e\n \u003cli\u003eSanchez‑Ramirez CA, Larrosa‑Haro A, Vasquez‑Garibay EM, Macias‑Rosales R. \u0026nbsp; Socio‑demographic factors associated with caustic substance ingestion in children and \u0026nbsp; adolescents. \u003cem\u003eInt J Pediatr Otorhinolaryngol\u003c/em\u003e. 2012;76(2):253‑6.\u003c/li\u003e\n \u003cli\u003ede Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30‑year review. \u003cem\u003eInt J Pediatr Otorhinolaryngol\u003c/em\u003e. 2001;57(3):203‑11.\u003c/li\u003e\n \u003cli\u003eBetalli P, Falchetti D, Giuliani S, et al. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. \u003cem\u003eGastrointest Endosc.\u003c/em\u003e 2008;68:434‑439. doi:10.1016/j.gie.2008.02.016.\u003c/li\u003e\n \u003cli\u003eBoskovic A, Stankovic I. Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children? \u003cem\u003eEur J Gastroenterol Hepatol\u003c/em\u003e. 2014;26(5):499‑503\u003c/li\u003e\n \u003cli\u003eKaya M, Ozdemir T, Sayan A, Arıkan A. The relationship between clinical findings and esophageal injury severity in children with corrosive agent ingestion\u003cem\u003e. Ulus Travma Acil Cerrahi Derg.\u0026nbsp;\u003c/em\u003e2010;16(6):537‑40.\u003c/li\u003e\n \u003cli\u003eSuzen A, Alev S, et al. T\u0026uuml;rkiye G\u0026uuml;neybatısı\u0026rsquo;ndan retrospektif \u0026ccedil;alışma: koroziv madde alımına minimal invaziv yaklaşım. \u003cem\u003eMuğla Sıtkı Ko\u0026ccedil;man \u0026Uuml;niversitesi Tıp Dergisi\u003c/em\u003e. 2021;82:80‑83.\u003c/li\u003e\n \u003cli\u003eRadhakrishna V, Kumar N, Gadgade BD, Vasudev RB, Alladi A. Sequelae of corrosive injury in children: an observational study. \u003cem\u003eJ Indian Assoc Pediatr Surg\u003c/em\u003e. 2022;27(4):435‑40. doi:10.4103/jiaps.jiaps_133_21.\u003c/li\u003e\n \u003cli\u003eBadiu Tisa I, Pepelea L, Pirvan A, Lupan I, Samasca G, Bordea A. Endoscopic grading as a predictor to develop strictures in corrosive esophagitis in children. \u003cem\u003eJ Clin Med.\u003c/em\u003e 2023;12(4):1699. doi:10.3390/jcm12041699.\u003c/li\u003e\n \u003cli\u003eQuitadamo P, di Lauri A, Albano R, Laudadio V, Gragnaniello P, Puoti MG, et al. The\u0026nbsp;effects of liquid bleach ingestion on children\u0026apos;s esophageal and gastric mucosa. \u003cem\u003eJ Pediatr \u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026nbsp;Gastroenterol Nutr.\u003c/em\u003e 2025;81(1):11‑7. doi:10.1002/jpn3.70063.\u003c/li\u003e\n \u003cli\u003eChibishev A, Simonovska N, Shikole A. Post‑corrosive injuries of upper gastrointestinal tract. \u003cem\u003eContrib Sec Biol Med Sci\u003c/em\u003e. 2010;31(1):45‑52. doi:10.1002/ejsp.2181.\u003c/li\u003e\n \u003cli\u003eGorman RL, Khin‑Maung‑Gyi MT, Klein‑Schwartz W, et al. Initial symptoms as predictors \u0026nbsp;of esophageal injury in alkaline corrosive ingestions. \u003cem\u003eAm J Emerg Med\u003c/em\u003e. 1992;10:189‑94. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;doi:10.1016/0735‑6757(92)90206‑D.\u003c/li\u003e\n \u003cli\u003eIrlayıcı FI, Elmas A, Akcam M. Corrosive substance ingestion in children: clinical features, management and outcomes in a tertiary care setting. \u003cem\u003eEur J Pediatr\u003c/em\u003e. 2025;184(9):549. doi:10.1007/s00431‑025‑06402‑3.\u003c/li\u003e\n \u003cli\u003eAkbay‑\u0026Ouml;nt\u0026uuml;rk Y, U\u0026ccedil;ar B. Eskişehir b\u0026ouml;lgesinde \u0026ccedil;ocukluk \u0026ccedil;ağı zehirlenmelerinin\u0026nbsp;retrospektif değerlendirilmesi. \u003cem\u003e\u0026Ccedil;ocuk Sağlığı ve Hastalıkları Dergisi\u003c/em\u003e. 2003;46:103‑13.\u003c/li\u003e\n \u003cli\u003eGupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenoscopy necessary for all\u0026nbsp;caustic ingestions? \u003cem\u003eJ Pediatr Gastroenterol Nutr\u003c/em\u003e. 2001;32(1):50‑3.\u003c/li\u003e\n \u003cli\u003eDi Nardo G, Betalli P, Illiceto MT, et al. Caustic ingestion in children: a year\u0026apos;s experience in 3 Italian referral centers. \u003cem\u003eJ Pediatr Gastroenterol Nutr\u003c/em\u003e. 2020;71(1):19‑22.\u003c/li\u003e\n \u003cli\u003eJA Haller HG Andrews JJ White 1971 Pathophysiology and management of acute corrosive burns of the esophagus: results of treatment in 285 children J Pediatr Surg 6 578 584 .\u003c/li\u003e\n \u003cli\u003eNgobese A, Govender S, Peer N , Sheik‑Gafoor MH. Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients \u0026nbsp; \u003cem\u003ePediatric Surgery International\u0026nbsp;\u003c/em\u003e(2022)38:505\u0026ndash;512\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUrganci N, Usta M, Kalyoncu D, Demirel E. Corrosive substance ingestion in children. \u003cem\u003eIndian J Pediatr\u003c/em\u003e. 2014;81(7):675‑79.\u003c/li\u003e\n \u003cli\u003eChibishev A, Pereska Z, Chibisheva V, et al. Corrosive poisonings in adults. \u003cem\u003eMater Sociomed. 2012;\u003c/em\u003e24(2):125‑30.\u003c/li\u003e\n \u003cli\u003eLupa M, Magne J, Guarisco JL, Amedee R. Update on the diagnosis and treatment of caustic ingestion. \u003cem\u003eOchsner J.\u003c/em\u003e 2009;9:54‑59. doi:10.1016/j.ad.2014.06.007.\u003c/li\u003e\n \u003cli\u003eSudarsi B, Rani K, Siddeswari R, et al. Clinical and endoscopic study of upper GI manifestation in corrosive acid ingestion\u003cem\u003e. Int J Sci Res Publ\u003c/em\u003e. 2015;5(2):1‑5.\u003c/li\u003e\n \u003cli\u003eChen TY , Ko SF, Chuang JH,Kuo HW,Tiao MM. Predictors of esophageal stricture in children with unintentional ingestion of caustic agents \u0026nbsp;Chang Gung Med J 2003 Apr;26(4):233-9.\u003c/li\u003e\n \u003cli\u003eElawady EH, Hafiz RN, Nasr MA. The prognostic value of some initial clinical manifestations and biochemical parameters for evaluating the outcome in corrosives‑poisoned children. \u003cem\u003eZagazig J Forensic Med Toxicol\u003c/em\u003e. 2017;15(1):1‑10.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"corrosive esophagitis, pan immune inflammation, systemic inflammatory index, children","lastPublishedDoi":"10.21203/rs.3.rs-8087399/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8087399/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: In our study, we aimed to investigate the effect on prognosis by evaluating whether there is a relationship between NLR, PLR, SII, SIRI, and PIV levels and symptoms in our patients who ingested corrosive substances. Additionally, we aimed to investigate the feasibility of using biomarkers as an alternative to endoscopy, an invasive procedure, thereby contributing to the development of a rapid and low-cost diagnostic approach in clinical management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Methods: \u003c/strong\u003eWe retrospectively analyzed 213 pediatric cases aged 0-18 years who presented to our hospital with corrosive esophagitis between 2018 and 2023. In the study, demographic data (age and gender) and laboratory parameters were recorded for each patient, and inflammation indices derived from these data, namely SII, SIRI, and PIV indices, were determined. Patients were examined in three groups according to the type of substance they swallowed: detergents, bleach and other corrosive substances, and sink unblockers and limescale removers. Additionally, two subgroups were formed based on the presence of symptoms: symptomatic and asymptomatic. Statistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA, License: Hitit University). Kolmogorov-Smirnov and Shapiro-Wilks tests, histograms, and Q-Q plots were used to assess the normal distribution of numerical data. Variance homogeneity was tested using the Levene test.In our study, neutrophil levels were significantly higher in the symptomatic group (p=0.016), while lymphocyte levels were lower (p=0.007). Consequently, NLR was markedly elevated in the symptomatic group (p=0.002). A sensitivity of 61.1% and a specificity of 90.3% were obtained for NLR. Similarly, PLR (p=0.006), SII (p=0.004), SIRI (p=0.020), and PIV (p=0.019) values were also found to be significantly higher in the symptomatic group. The likelihood of symptom development was significantly higher in the drain openers and descalers group compared to the detergent group (OR=6.66; 95% CI: 1.04–42.9; p=0.046). Furthermore, the risk of symptom development in patients with NLR ≥2.15 was significantly higher compared to those with low NLR levels (OR=17.6; 95% CI: 5.6–55.5; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBlood parameter values are predicted to be a good indicator of the severity of corrosive esophagitis and may help predict the degree of mortality and morbidity. This prevents unnecessary endoscopies as an invasive method.\u003c/p\u003e","manuscriptTitle":"A New Biomarker in the Diagnosis of Pediatric Corrosive Esophagitis: Pan-Immune Inflammatory Score and Systemic Inflammatory Index: Can esophagoscopy be omitted in asymptomatic patients?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 08:50:12","doi":"10.21203/rs.3.rs-8087399/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-25T05:54:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T12:06:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268345109600163117379391310621811311403","date":"2026-02-03T11:52:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-21T08:39:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197849353434694376763066241608903958394","date":"2026-01-11T19:50:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-09T16:08:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T11:57:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-01-07T11:46:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"465e6b4f-72cb-4f39-8916-cb219cdd5523","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T07:09:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 08:50:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8087399","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8087399","identity":"rs-8087399","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}