الفهرس 
IntroductionOnly 14 pages are availabe for public view
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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
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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.