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Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

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Original Article
Evaluation of the Pan-Immune-Inflammation Value (PIV) as a prognostic and surgical decision-making marker in necrotising enterocolitis
Abstract
Aims: Necrotizing enterocolitis (NEC) is a complex gastrointestinal disorder characterized by intestinal wall necrosis and a high mortality rate. The pan-immune-inflammation value (PIV) is a novel biomarker that reflects systemic inflammation and immune response, calculated from blood counts of neutrophils, platelets, monocytes, and lymphocytes. The present study evaluates the utility of PIV, an accessible and cost-effective parameter, in patients with NEC and investigates its potential to differentiate between those who recover with medical management and those who require surgical intervention. Materials and
Methods: Data from 793 patients admitted to the Neonatal Intensive Care Unit (NICU) between May 2018 and November 2022 were analyzed in a retrospective single-centre cohort study. The study included 40 NEC patients (Stages 1, 2, and 3) and 753 control subjects (218 preterm, 535 term). The PIV [(Neutrophils × Platelets × Monocytes) / Lymphocytes] was calculated using complete blood count results obtained on postnatal days 0 and 1, at the NEC diagnosis time point (with postnatal-age-aligned control measurements) and, for NEC cases, at discharge/death. Because PIV values were markedly right-skewed and the Shapiro–Wilk test rejected normality in every group at every time point (all p<0.001), unadjusted between-group comparisons were performed with Kruskal–Wallis tests and Dunn–Bonferroni post-hoc tests; repeated measurements were analysed with a linear mixed model on log-transformed PIV for the time × group interaction. Receiver operating characteristic (ROC) analysis and multivariable logistic regression adjusted for gestational age and birth weight were performed to assess whether PIV predicts the need for surgery.
Results: PIV values showed significant differences between the study groups on postnatal day 0 (p=0.001) and day 1 (p<0.001). In contrast, PIV values were comparable between the groups at the time of NEC diagnosis (p=0.358) and did not differ significantly according to NEC stage at discharge or death (p=0.875).Contrary to the pattern suggested by group means, median PIV in the surgical NEC group was not the highest at any time point, and Dunn–Bonferroni post-hoc testing identified only one significant pair (Bell I vs term controls on day 1, p=0.005). ROC analysis showed no evidence of discriminative ability of PIV for the need for surgery at any evaluated time point (AUC 0.42–0.58; all 95% CIs included 0.50). PIV was not an independent predictor of surgery in multivariable logistic regression (day 1: OR 1.0004, 95% CI 0.9998–1.0009, p=0.164). The unadjusted NEC–control differences disappeared after adjustment for gestational age and birth weight (day 0: p=0.858; day 1: p=0.339), and the time × group interaction was not significant (p=0.656).
Conclusion: In this retrospective single-centre cohort, PIV did not discriminate NEC cases requiring surgery from those managed medically, and the apparent NEC–control differences were largely explained by gestational age and birth weight. These findings do not support the use of PIV as a stand-alone marker for surgical decision-making in NEC. Given the small surgical subgroup (n=13), the study is hypothesis-generating and the results require confirmation in larger, prospective, multicentre cohorts.

Keywords : Necrotising Enterocolitis, Pan-Immune-Inflammation Value, Surgical NEC, Prematurity, Biomarker

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Ethical Statement

The study protocol was approved by the Ethics Committee for Non-interventional Clinical Researches at Gülhane Training and Research Hospital, University of Health Sciences (Date: 17.05.2023, Decision No: 2023/119).

Informed Consent

This retrospective study used pre-existing anonymized patient data. No additional intervention was performed, and there was no direct patient contact. The study was approved by the Ethics Committee, and the requirement for written informed consent was waived by the ethics committee.

Author Contributions

Concept: IY, IS; Design: IY, IS; Control: IY, IS; Resources: IY, SEUB, GBB, IS; Materials: IY, SEUB, GBB, IS; Data Collection and/or Processing: IY, SEUB; Analysis and/or Interpretation: GBB, IS; Literature Review: GBB, IS; Critical Review: GBB, IS; Final Approval: IY, GBB, IS; Accountability: IY, IS.

Conflict of Interest

The authors declare no conflicts of interest related to this study.

Financial Disclosure

The authors received no financial support for the conduct or publication of this research.


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Article available in :
Volume 3, Issue 4, 2026
Page : 126-132
https://doi.org/10.51271/SOC-0085
Article Information
Received : 13 Tem 2026
Accepted : 08 Eki 2026
Published : 20 Eki 2026
Corresponding Author :

İbrahim Yıldırım: Department of Pediatric Surgery, Eskişehir City Hospital, Eskişehir, Turkiye

[email protected]
Citation : Yıldırım İ, Ünlü Ballı SE, Bahadır GB, Sürer İ. Evaluation of the pan-immune-inflammation value (PIV) as a prognostic and surgical decision-making marker in necrotising enterocolitis. Surg Child. 2026;3(4):126-132. doi:10.51271/SOC-0085

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