Correlation of Some RBCs and Platelets Indices with Outcome of Critically Ill Children Admitted to Pediatric Intensive Care Units

Abstract

Background: Platelet and Red blood cell indices ratios serve as a simple and convenient stratification tool for illness severity predictors in pediatric intensive care unit (PICU) mortality. The aim of the current study was toevaluate the ability of red cell distribution width (RDW) and platelet indices and ratios to predict mortality. Patients and methods: A prospective, observational study was conducted on 99 critically ill children of both sexes admitted to PICU of Benha University Hospitals and Benha Children Hospital (BENCH). All children incorporated in this study were subjected to careful history taking, clinical examination, complete blood count (CBC) and scoring by the third-generation pediatric index of mortality (PIM-3). Results: Our results showed that RDW, platelet counts and platelet indices ratios independently predicted PICU mortality. RDW measured within 24 hours of PICU admission was independently associated with mortality (p=0.001). Although RDW demonstrated high sensitivity (94.8 %) but low specificity (37.1%) as an independent predictor of mortality, it corresponded fairly to sensitivity and specificity of PIM-3 score in the present study. This is an important observation as a low-cost test of RDW performed nearly at par with more complex index of mortality. Regarding platelet indices, our study found that the platelet ratios [Mean platelet volume (MPV)/ plateletcrit (PCT), MPV/ platelet count, platelet differential width (PDW)/PCT, PDW/Platelet count] were better predictors of mortality than platelet indices by themselves. All the ratios of platelet indices were statistically significant (p-value <0.05). Conclusion: RDW, platelet count, and platelet indices ratios were independent predictors of PICU mortality. The predictive power of these indices was comparable to the PIM-3 score.

Platelet indices as a predictor of mortality in critically ill children

“…Conversely, there was a significant decrease in platelet count and Plateletcrit (PCT) in nonsurvivors, also with a p-value of less than 0.001. These findings align with the results obtained by Aliaa Mohammed Diab et al [9] in their investigation correlating certain red blood cell (RBC) and platelet indices with the outcomes of critically ill children in pediatric intensive care units. Their study identified significant associations, particularly with Platelet count (PLT) (*10^3 /ml) (p value = 0.002), Plateletcrit (PCT) (%) (p-value = 0.005), and Mean Platelet Volume (MPV) (FL) (p-value = 0.158).…”

“…In the present study as regarding to sex there was no significant difference between the two main studied groups ~ 31 ~ with (p-value=0.168) with male predominance in both groups. This aligns with the findings of Aliaa Mohammed Diab et al [9] , who conducted a prospective observational study on 99 critically ill children admitted to pediatric intensive care units (PICUs) at Benha University Hospital and Benha Children Hospital. The study, conducted between April 1, 2018, and September 30, 2018, revealed no statistically significant difference in sex (p-value 0.89).…”

“…In the present study as regarding to CBC (Complete Blood Count) results other than platelet indices in both studied groups there was significant increase in Hb (Hemoglobin), MCV (Mean Corpscular Volume), MCH (Mean Corpscular Hemoglobin Concentration) and Lymphocytic count in Control group with (p-value < 0.001), While TLC and Neutrophilic count showed significant increase in patient group with (p-value < 0.001). This aligns with the research conducted by Aliaa Mohammed Diab et al [9] , where they investigated the correlation between certain red blood cell Anemia in critically ill children could be explained by multifactorial etiology and includes diminished erythropoietin activity, poor iron use by the body, and blood loss (both iatrogenic and noniatrogenic). Also the association between leukocytosis and critical illness can be explained by various mechanisms according to the primary diagnosis for example in septic patients one explanation could be the higher dose of infecting organisms.…”

“…In the present study as regarding to correlation between platelet indices and each others PDW (Platelet Distribution Width) and MPV (Mean Platelet volume) are directly related to each others and both are inversely related to PCT (Plateletcrit) and Platelet count. This was similar to [9] Aliaa Mohammed Diab, et al In their study in which they correlate Some RBCs and Platelets Indices with the outcome of critically ill children. And also agreed by [10] Samira Z. Sayed, et al 2020 on their study that examined the admission of platelet count and indices as predictors of outcome in children with severe Sepsis.…”

“…In [10] Samira Z. Sayed, et al 2020 the mortality rate was 31% and all cases were diagnosed with severe sepsis. This was close to (9) Aliaa Mohammed Diab, et al Where the overall mortality rate was 37.7% and the commonest causes of admission in their PICUs were respiratory diseases (28.2%) followed by neurological insult (23.2%) and the least diagnosis were hepatic diseases and poisoning (2%). Also It comes in agreement with [11] Rehab Salah Taha, et al In their study the estimated mortality rate was 35% despite the difference in age groups and all patients were diagnosed with sepsis.…”