Complete blood counts and their derived inflammatory markers with anal fistulas in male children: A retrospective case-control study

doi:10.3748/wjg.v31.i45.112926

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

World J Gastroenterol. Dec 7, 2025; 31(45): 112926
Published online Dec 7, 2025. doi: 10.3748/wjg.v31.i45.112926

Complete blood counts and their derived inflammatory markers with anal fistulas in male children: A retrospective case-control study

Huang-Fu Ma, Yi-Hao Chen, Yue Wang, Xue-Cheng Zhang, Jia-Nan Li, Yan-Mei Wang, Zhang-Yun Zhou

Huang-Fu Ma, Yue Wang, Xue-Cheng Zhang, Jia-Nan Li, Yan-Mei Wang, Department of Proctology, China-Japan Friendship Hospital, Beijing 100029, China

Yi-Hao Chen, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China

Zhang-Yun Zhou, Department of Gastrointestinal Surgery, Anhui Zhongke Gengjiu Hospital, Hefei 230051, Anhui Province, China

Co-first authors: Huang-Fu Ma and Yi-Hao Chen.

Author contributions: Ma HF and Chen YH drafted the manuscript, they contributed equally to this work; Zhang XC and Wang Y performed the statistical analyses and created the figures; Li JN, Zhou ZY, and Wang YM contributed to the manuscript review; Ma H and Wang Y conceived the study and contributed to the manuscript review; all the authors have read and approved the final version of the manuscript.

Supported by the China-Japan Friendship Hospital Scientific Research Fund, No. 2024-ZF-31 and No. 2024-ZF-12.

Institutional review board statement: The study protocol was approved by the ethics committee of China-Japan Friendship Hospital (approval No. 2024-KY-387).

Informed consent statement: All data used in this study were utilized under a waiver of informed consent, and no separate informed consent was obtained from the parents or legal guardians of minors.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Huang-Fu Ma, MD, Doctor, Department of Proctology, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing 100029, China. mahuangfu@zryhyy.com.cn

Received: August 11, 2025
Revised: September 3, 2025
Accepted: October 22, 2025
Published online: December 7, 2025
Processing time: 116 Days and 1.2 Hours

Abstract

BACKGROUND

Perianal abscesses (PA) and pediatric fistula-in-ano (PFIA) are stages of the same perianal infectious disease, with PFIA often developing from PA. In children, PFIA predominantly affects male infants under one year, mostly involving low-level fistulas. The pathogenesis remains unclear, though infection and inflammation play central roles. Novel inflammatory markers, such as systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), provide valuable insights into immune-inflammatory status. However, the relationship between complete blood count (CBC) derived markers and PFIA has not been investigated. This study evaluates CBC and its derivatives in PFIA to inform diagnosis, prognosis, and prevention strategies.

AIM

To analyze changes in CBC and inflammatory markers in male infants and toddlers with PFIA.

METHODS

Among 974 male infants and toddlers under six years of age, the case and control groups comprised 681 patients with PFIA and 293 healthy individuals, respectively. The CBC results and derived inflammatory markers, including the SIRI, SII, NLR, PLR, and MLR, were analyzed. The associations between PFIA and CBC-related inflammatory markers were also investigated. Finally, the predictive values of these markers were evaluated.

RESULTS

PFIA was significantly associated with CBC-derived inflammatory markers. Compared with healthy controls, patients with PFIA demonstrated higher lymphocyte and lower MLR and SIRI levels, which remained robust after adjusting for patient age. Lymphocyte count, MLR, and SIRI had high predictive values. Additionally, lymphocyte count, MLR, and SIRI showed high clinical utility across a wide range of threshold probabilities, thus enhancing early detection and prognostic prediction. Finally, the number of fistula tracts in patients was significantly correlated with lymphocyte, MLR, and SIRI levels.

CONCLUSION

Lymphocyte count may be an inflammatory biomarker in the evaluation of PFIA among male infants and toddlers. Closer clinical observation and timely preventive or diagnostic measures will be beneficial.

Keywords: Complete blood count; Diagnostic performance; Inflammatory biomarkers; Pediatric perianal fistula; Male children

Core Tip: This retrospective case-control study analyzed 974 male infants and toddlers, including 681 with pediatric fistula-in-ano (PFIA) and 293 healthy controls, to assess the relationship between complete blood count-derived inflammatory markers and PFIA. Patients showed higher lymphocyte counts but lower monocyte-to-lymphocyte ratio (MLR) and systemic inflammatory response index (SIRI) levels, which remained significant after age adjustment. Lymphocyte count, MLR, and SIRI demonstrated strong predictive value and clinical utility for PFIA detection and prognosis. The number of fistula tracts correlated with these markers. Lymphocyte count may serve as a useful biomarker, supporting early diagnosis and targeted prevention in pediatric PFIA.