Platelet Indices as Predictive Markers of Prognosis in Pediatric Septic Shock Patients

Abstract

Background: Platelet indices are used as predictive marker of mortality in adult critically ill patients. Objectives: To compare platelet counts, mean platelet volumes (MPV), and platelet distribution widths (PDW) in surviving and non-surviving pediatric septic shock patients and to assess whether platelet count and indices can be utilized as predictive markers of mortality in these patients. Methods: A retrospective study was performed based on collected data on pediatric patients admitted for septic shock to pediatric intensive care unit. Complete blood cell count, platelet counts, MPV, and PDW on admission were compared in survivors and non-survivors, as well as in patients with and without underlying hemato-oncologic disease. Results: Of 83 children, 21 (25.3%) died within 28 days of hospital admission. Mean platelet count was significantly higher in the 62 survivors than in 21 non-survivors (146.6 ± 133.7 × 103/mm3 vs 46.1 ± 44.1 × 103/mm3, P = 0.000). MPV and PDW were also higher in survivors, though not statistically significant (P = 0.059, P = 0.077). The platelet counts were significantly higher in survivors than in non-survivors with (P = 0.044) and without (P = 0.015) hemato-oncologic disease. Based on area under receiver operating characteristic curves, platelet count was the strongest predictor of mortality in pediatric patients without underlying hemato-oncologic disease (area under the curve = 0.857). The survival probability in this group was 96.77% when platelet count exceeded 106.5 × 103/mm3. Conclusions: Thrombocytopenia is a useful predictive marker of mortality in pediatric septic shock patients, both with and without underlying hemato-oncologic disease.