The role of systemic immune-inflammation index (SII) in the differential diagnosis of granulomatous and reactive LAP diagnosed by endobronchial ultrasonography Evaluation of the systemic immune-inflammation index in sarcoidosis, tuberculosis and reactive lymphadenitis

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Buğra Kerget
Dursun Erol Afşin
Alperen Aksakal


Sarcoidosis, tuberculosis, SII


Background and aim: Tuberculosis and sarcoidosis are the two most important granulomatous diseases that physicians have difficulty in differential diagnosis. In our study, we aimed to observe the place of systemic immune-inflammation index (SII) level in the differentiation of patients diagnosed with endoboronchial ultrasonography (EBUS).

Methods: Our study included 494 patients who applied to our hospital's chest diseases outpatient clinic between 2015 and 2020 and underwent endobronchial ultrasonography (EBUS) for mediastinal lymphadenopathy (LAP). Patients' follow-up for at least 2 years after diagnosis and pre-procedural hematologic parameters were retrospectively recorded.

Results: In the comparison of SII between groups, it was observed that SII was statistically significantly higher in patients followed up for tuberculous lymphadenitis compared to patients with sarcoidosis and reactive LAP (p=0.01, <0.001). In sarcoidosis patients, SII levels were statistically significantly higher than in patients with reactive LAP (p=0.002). Platelet, sedimentation and SII levels were statistically significantly higher in stage 2 patients compared to stage 1 patients, while lymphocyte levels were lower (p=0.009, 0.001, 0.001, 0.001, 0.001 respectively). In the ROC curve analysis of the SII level of patients with sarcoidosis and tuberculosis LAP, the AUC was 0.668 and when the cut-off value for the SII level was 890.667, the sensitivity was 70% and the specificity was 66% in the differentiation of tuberculosis and sarcoidosis lymphadenitis.

Conclusion: SII may be an easily applicable parameter in the differentiation of tuberculosis and sarcoidosis LAP with granuloma and in the differentiation of granulomatous diseases from reactive LAP.


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1. Low SY, Koh MS, Ong TH, et al. Use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenopathy. Ann Acad Med Singapore. 2014;43:250-4.
2. Adams D. The granulomatous inflammatory response. A review. The American journal of pathology. 1976;84:164.
3. Erbay M, Özsu S, ES AM, et al. Causes of mediastinal/hilar granulomatous lymphadenitis. Tuberkuloz ve Toraks. 2018;66:212-6.
4. Raviglione M, Harries A, Msiska R, et al. Tuberculosis and HIV: current status in Africa. AIDS (London, England). 1997;11:S115-S23.
5. Hopewell PC, Jasmer RM. Overview of clinical tuberculosis. Tuberculosis and the tubercle bacillus. 2004:13-31.
6. Geldmacher H, Taube C, Kroeger C, et al. Assessment of lymph node tuberculosis in northern Germany: a clinical review. Chest. 2002;121:1177-82.
7. El‐Zammar O, Katzenstein AL. Pathological diagnosis of granulomatous lung disease: a review. Histopathology. 2007;50:289-310.
8. Shah KK, Pritt BS, Alexander MP. Histopathologic review of granulomatous inflammation. Journal of clinical tuberculosis and other Mycobacterial Diseases. 2017;7:1-12.
9. Lynch III JP, Kazerooni EA, Gay SE. Pulmonary sarcoidosis. Clinics in chest medicine. 1997;18:755-85.
10. Kerget B, Aydin Y, Özmen S, et al. Can hematological parameters guide the differentiation between sarcoidosis and tuberculous lymphadenitis? Eurasian Journal of Pulmonology. 2021;23:19.
11. Hunter RL. Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis. Tuberculosis. 2016;97:8-17.
12. Mortaz E, Masjedi MR, Abedini A, et al. Common features of tuberculosis and sarcoidosis. International Journal of Mycobacteriology. 2016;5:S240-S1.
13. Maertzdorf J, Weiner 3rd J, Mollenkopf H-J, et al. Common patterns and disease-related signatures in tuberculosis and sarcoidosis. Proceedings of the National Academy of Sciences. 2012;109:7853-8.
14. Gupta D, Agarwal R, Aggarwal AN, et al. Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders. Current opinion in pulmonary medicine. 2012;18:506-16.
15. Agrawal R, Kee AR, Ang L, et al. Tuberculosis or sarcoidosis: opposite ends of the same disease spectrum? Tuberculosis. 2016;98:21-6.
16. Chen ES, Song Z, Willett MH, et al. Serum amyloid A regulates granulomatous inflammation in sarcoidosis through Toll-like receptor-2. American journal of respiratory and critical care medicine. 2010;181:360-73.
17. Dhand R, De A, Ganguly N, et al. Factors influencing the cellular response in bronchoalveolar lavage and peripheral blood of patients with pulmonary tuberculosis. Tubercle. 1988;69:161-73.
18. Sweiss NJ, Salloum R, Ghandi S, et al. Significant CD4, CD8, and CD19 lymphopenia in peripheral blood of sarcoidosis patients correlates with severe disease manifestations. PLoS One. 2010;5:e9088.
19. Nakao M, Muramatsu H, Arakawa S, et al. Immunonutritional status and pulmonary cavitation in patients with tuberculosis: A revisit with an assessment of neutrophil/lymphocyte ratio. Respiratory investigation. 2019;57:60-6.
20. Abakay O, Abakay A, Sen HS, et al. The relationship between inflammatory marker levels and pulmonary tuberculosis severity. Inflammation. 2015;38:691-6.
21. Golden MA, Au Y, Kirkman TR, et al. Platelet-derived growth factor activity and mRNA expression in healing vascular grafts in baboons. Association in vivo of platelet-derived growth factor mRNA and protein with cellular proliferation. The Journal of clinical investigation. 1991;87:406-14.
22. Tozkoparan E, Deniz O, Ucar E, et al. Changes in platelet count and indices in pulmonary tuberculosis. 2007.
23. Chen G, Wu C, Luo Z, et al. Platelet–lymphocyte ratios: a potential marker for pulmonary tuberculosis diagnosis in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease. 2016;11:2737.