الفهرس 
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Abstract
Sepsis is the clinical syndrome resulting from the inflammatory response of the host against various invading pathogens such as bacterial infections. suPAR has been proposed as a prognostic biomarker in various diseases and conditions. Thrombocytopenia was previously evaluated as a prognostic marker in ICU patients and was found to be correlated with the risks for a prolonged ICU stay and mortality.
The aim of our study was to evaluate the prognostic value of thrombocytopenia, in critically ill patients with severe sepsis. Its relationship to mean platelet volume (MPV), platelet distribution width (PDW) and urokinase-type plasminogen activator receptor (suPAR).
The study was carried out on 60 infants and children. They were diagnosed as having severe sepsis or septic shock according to international pediatric sepsis consensus conference criteria, 2005. They were grouped as following: group A (Thrombocytopenic group): 30 children diagnosed as having severe sepsis or septic shock, with a platelet count < 150,000/cmm.
group B (Non-thrombocytopenic group): 30 children diagnosed as having severe sepsis or septic shock, with a platelet count ≥ 150,000/cmm. In addition, 30 children, age and sex matched with the previous two groups, were enrolled as control group.
Blood samples were withdrawn from all included children for complete blood picture (CBC) including platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT). Also, liver function test (LFT), renal function test (RFT), serum suPAR, C-reactive protein (CRP) were assessed.
In this study, we found that the thrombocytopenic group had higher PRISM score and lower survival rate than the non-thrombocytopenic group.
Regarding the platelet parameters, the two severe sepsis groups had higher MPV and lower PCT than the control group. But only the thrombocytopenic group had higher PDW than the control group. Also, the two severe sepsis groups had significantly higher serum suPAR level than the control group. Moreover, the thrombocytopenic group had significantly higher serum suPAR level than the non-thrombocytopenic group.
We found that PRISM score had significant negative association with both platelet count (r=-0.420, p=0.001) and plateletcrit (r=-0.442, p=0.001), confirming their negative prognostic value. Also, PRISM score had a significant positive association with suPAR level.
We found that the increase in suPAR by one unit will increase the risk of mortality by11%, and the increase in MPV by one unit will increase the risk of mortality by 31%. While the increase in the platelet count by one unit will decrease the risk of mortality by 1% and the increase in plateletcrit by one unit will decrease the risk of mortality by 100%.
In conclusion the existence of thrombocytopenia in critically ill patient is associated with bad prognosis and higher mortality. Platelet indices are good prognostic markers in sepsis specially plateletcrit, at the cutoff point ≤ 0.17%, was the most sensitive parameter (94.74%) for predicting death with the highest NPV (97%). suPAR is a also a good prognostic biomarker for sepsis outcome.