The predictive role of early and late-stage inflammatory markers in the development of retinopathy of prematurity in discordant twins.

BACKGROUND: To evaluate the predictive value of systemic inflammatory markers, including Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), and Aggregate Index of Systemic Inflammation (AISI), on the development of retinopathy of prematurity (ROP) on the 1st day and 1st month in discordant twins. METHODS: A total of 91 premature twin pairs were included in this retrospective study. Among these, 12 twin pairs in which ROP developed in one twin but not the other (discordant) were included in the analysis. The infants' clinical factors and blood count parameters on the postnatal 1st day and 1st month, along with the NLR, SII, and AISI values calculated from these, were compared. RESULTS: No statistically significant differences were found between the ROP(+) and ROP(-) groups in terms of Apgar scores, birth weight (BW), or additional comorbidities. On postnatal day 1, AISI [183.82 (142.77-575.42) vs 107.78 (76.61-157.92), p = 0.014], SII (p = 0.017), and NLR (p = 0.041) values were significantly higher in the ROP(+) group. AISI showed the highest discriminative performance (AUC = 0.818, p = 0.014). An AISI cut-off value of ≥170 was associated with increased risk of ROP(OR = 23.33, p = 0.012). At 1 month of age, AISI remained significantly elevated in the ROP(+) group [115.36 (90.37-374.07) vs 62.21 (36.81-63.04), p = 0.030], whereas NLR and SII were no longer different between groups. An AISI cut-off value of ≥67.61 was associated with increased risk of ROP (OR = 24.0, p = 0.041). Additionally, AISI was not identified as an independent predictor of ROP development in univariate logistic regression analyses. CONCLUSION: In discordant twins sharing the same intrauterine environment and gestational age, AISI may represent a potential inflammatory biomarker associated with ROP development on the postnatal 1st day and at 1 month.