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Abstract Platelet (PLT), a major and essential constituent of blood, plays an important role in physiological and pathological processes such as coagulation, thrombosis, inflammation and maintenance the integrity of vascular endothelial cells. PLT indices are a group of parameters that are used to measure the total amount of PLTs, PLTs morphology and proliferation kinetics. The commonly used PLT indices include PLT count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet-crit (PCT). The MPV refers to the ratio of PCT to PLT count. PDW is numerically equal to the coefficient of PLT volume variation, which is used to describe the dispersion of PLTs volume. Platelets are versatile cells. They participate in the inflammatory process, wound healing, angiogenesis, tissue regeneration and in endothelial barrier function. This multi-functionality explains the frequent finding of low platelet count among critically ill children. In-hospital mortality depends on the severity of the illness at the time of admission. Severity of illness scores have been developed to predict the mortality in the Intensive Care Unit (ICU). Scoring systems such as the PIM II (Pediatric Index of Mortality III), PRISM score (Pediatric Risk of Mortality), SICK score (Signs of Inflammation that Can Kill) is severity of illness scores used in children. The current study aimed to assess role of platelet indices in diagnosis and prognosis of critically ill children, in Pediatric Intensive Care Unit of Menoufia University Hospital. The study was conducted on 133 children admitted to Pediatric Intensive Care Unit at Menoufia University Hospital. Inclusion criteria: Age more than one month and younger than 18 years. Any child admitted to pediatric intensive care unit with critical illness. Exclusion criteria: age under 1 month or older than 18 years, and patients who died or were transferred to the general ward within 24 h after ICU admission. Patients were evaluated on admission by routine laboratory biomarkers, including Platelet Distribution Width, Mean Platelet Volume and Plateletcrit in Summary 101 addition to clinical risk score. Patients were followed up till hospital discharge. The primary outcome was PICU mortality. Results were summarized as follow: ● PRISM mortality risk%, PIM2 mortality risk% and pSOFA scores had a median of 2.3, 2.4 and 5 respectively. Mortality was (20.3%) in our study sample. ● There was statistically significant difference among different groups of sepsis, non-infectious SIRS and Non-SIRS regarding CRP level. While no statistically significant difference was found regarding platelet indices or other laboratory variables. ● Non-survivors had significant higher frequency of severe sepsis, ARDS, mechanical ventilation, MODS and nosocomial infection. Non survivors also had significantly higher pSOFA score, PRISM, and longer duration of mechanical ventilation. While WBC, platelet count and albumin were significantly lower among non-survivor group. ● PRISM, pSOFA, MV, ARDS, severe sepsis, CRP, Platelet count and serum albumin were independent predictors of mortality. ● PDW was positively correlated with pSOFA, MPV, PCT, Neutrophil count, WBC, platelet count, creatinine, ALT and serum albumin. ● MPV was positively correlated with pSOFA, PDW, PCT, Neutrophil count, WBC, platelet count, creatinine, ALT and serum albumin. ● PCT was positively correlated with pSOFA, MPV, PDW, lymphocytes, WBC, platelet count, creatinine, ALT and serum albumin. ● CRP and MPV had the largest area under the curve (ROC) for prediction of mortality followed by platelets, then serum albumin, CRP level had a sensitivity of 71.4% and a specificity of 54.3%for prediction of mortality. MPV level had a sensitivity of 67.9%and a specificity of 59%for prediction of mortality. |