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Background <p>The initial clinical and abdominal imaging manifestations of neonatal necrotizing enterocolitis (NEC) and food protein-induced enterocolitis syndrome (FPIES) can be similar, leading to diagnostic challenges. However, their prognoses and treatment strategies differ significantly. This study aimed to evaluate the utility of the Systemic Immune-Inflammation Index (SII) as a biomarker for differentiating NEC from highly suspected early-onset FPIES (HSEO-FPIES).</p> Method <p>This prospective cohort study enrolled neonates admitted with gastrointestinal symptoms (bloody stools, vomiting, or abdominal distension) who underwent abdominal imaging. Three groups were compared: NEC (modified Bell’s stage II/III, <i>n</i> = 49), HSEO-FPIES (international consensus criteria, <i>n</i> = 36), and a control group of neonates with jaundice but no gastrointestinal pathology (<i>n</i> = 27). Blood samples were collected prior to any therapeutic intervention. The primary endpoint was the diagnostic accuracy of SII for distinguishing NEC from HSEO-FPIES, measured by area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Secondary endpoints included comparison with C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell (WBC) count, as well as the performance of combined biomarkers.</p> Result <p>SII levels were significantly higher in the NEC group than in the HSEO-FPIES group (<i>p</i> &lt; 0.0001). SII achieved an AUC of 0.83 for differentiating NEC from HSEO-FPIES, with a sensitivity of 81.63% and specificity of 66.74% at a cut-off of 394.20. The AUC of SII was superior to that of IL-6 (0.70), CRP (0.75), and WBC (0.67). Combining SII with CRP improved the AUC to 0.89.</p> Conclusion <p>Compared with conventional single inflammatory markers, SII demonstrates superior integrative capacity, potential for dynamic monitoring, and clinical accessibility. It may serve as a promising novel biomarker to aid in the differential diagnosis of NEC and HSEO-FPIES.</p>

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SII as a potential biomarker for distinguishing between necrotizing enterocolitis and food protein-induced enterocolitis syndrome with radiographic abdominal gas signs

  • 期刊论文

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  • 发表日期：

    2026年5月15日

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  • Xiaoyan Yu,
  • Li Zeng,
  • Zhixin Song,
  • Hongdong Li,
  • Xi Yuan

摘要

Background

The initial clinical and abdominal imaging manifestations of neonatal necrotizing enterocolitis (NEC) and food protein-induced enterocolitis syndrome (FPIES) can be similar, leading to diagnostic challenges. However, their prognoses and treatment strategies differ significantly. This study aimed to evaluate the utility of the Systemic Immune-Inflammation Index (SII) as a biomarker for differentiating NEC from highly suspected early-onset FPIES (HSEO-FPIES).

Method

This prospective cohort study enrolled neonates admitted with gastrointestinal symptoms (bloody stools, vomiting, or abdominal distension) who underwent abdominal imaging. Three groups were compared: NEC (modified Bell’s stage II/III, n = 49), HSEO-FPIES (international consensus criteria, n = 36), and a control group of neonates with jaundice but no gastrointestinal pathology (n = 27). Blood samples were collected prior to any therapeutic intervention. The primary endpoint was the diagnostic accuracy of SII for distinguishing NEC from HSEO-FPIES, measured by area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Secondary endpoints included comparison with C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell (WBC) count, as well as the performance of combined biomarkers.

Result

SII levels were significantly higher in the NEC group than in the HSEO-FPIES group (p < 0.0001). SII achieved an AUC of 0.83 for differentiating NEC from HSEO-FPIES, with a sensitivity of 81.63% and specificity of 66.74% at a cut-off of 394.20. The AUC of SII was superior to that of IL-6 (0.70), CRP (0.75), and WBC (0.67). Combining SII with CRP improved the AUC to 0.89.

Conclusion

Compared with conventional single inflammatory markers, SII demonstrates superior integrative capacity, potential for dynamic monitoring, and clinical accessibility. It may serve as a promising novel biomarker to aid in the differential diagnosis of NEC and HSEO-FPIES.