Systemic Inflammatory and Immunonutritional Indices for Discriminating Ruptured From Non-Ruptured Endometriomas: A Retrospective Study

Objective: Ruptured endometrioma is an uncommon but clinically important emergency that often mimics other causes of acute abdomen, making timely diagnosis challenging. This study aimed to assess whether inflammatory and immunonutritional indices measured at presentation could discriminate ruptured from non-ruptured endometriomas before surgery.Methods: This retrospective cohort study included 77 women diagnosed with endometrioma between January 2020 and June 2026. Demographic characteristics, laboratory findings, surgical data, and inflammatory indices, including NLR, PLR, SII, SIRI, AISI, dNLR, NPAR, ACR, PNI, HALP, and CLR, were analyzed. Patients were compared according to disease laterality and rupture status. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate diagnostic performance.Results: Among the included patients, 57 (74.0%) had unilateral and 20 (26.0%) had bilateral endometriomas. Seven patients (9.1%) experienced spontaneous rupture. No significant differences were observed between unilateral and bilateral disease regarding demographic features, cyst size, hematological parameters, or inflammatory indices. In contrast, patients with ruptured endometriomas had significantly higher SII, SIRI, NLR, NPAR, AISI, and dNLR values than those without rupture. SIRI (AUC 0.865), AISI (AUC 0.861), and dNLR (AUC 0.861) demonstrated the highest diagnostic performance for discriminating of rupture, whereas albumin-based indices, including PNI and ACR, showed limited discriminatory ability.Conclusions: Routine blood count-derived inflammatory indices, particularly SIRI, AISI, and dNLR, may serve as simple, inexpensive, and widely available adjunctive biomarkers for identifying patients at increased risk of endometrioma rupture before surgery. Although these findings require external validation in larger prospective cohorts, they suggest that systemic inflammatory profiling may improve preoperative risk stratification in women presenting with endometrioma.