Platelet indices in children with sepsis and their relation to the outcome

Introduction: Sepsis is a major causes of mortality and morbidity among children. An effective and accurate biochemical marker is needed which can support or exclude the diagnosis of sepsis. Objective: To study the platelet indices in children with sepsis and their relation to the outcome Method: A prospective observational study was conducted in a tertiary care centre from southern India from October 2015 to July 2017. Children aged 1 month to 18 years of age with sepsis, as per the definition of International Paediatric Sepsis Consensus Conference 2005, were included in the study. Children with no infection were taken as controls. Children with haematological malignancies, known platelet disorders, haemolytic anaemia and children with a history of recent blood transfusions or splenectomy were excluded from the study. History and physical examination findings were noted in a pre-designed proforma. Platelet indices were measured using an automated blood counter, Beckman Coulter LH780 series. Counts done at the time of admission and prior to discharge or death were taken for analysis. Mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) values were compared with standard normal values. Severity of thrombocytopenia was classified as mild (50,000- 150,000/cu mm), moderate (20,000-50,000/cu mm) and severe ( < 20,000 or < 50,000/cu mm with clinical bleeding) for the study purpose. Mean and median were used for data with normal and nonnormal distribution. Mann-Whitney was used for analysis of continuous variables. Chi-square was used for categorical variables. Analysis of mean was done using independent t-test. Data was analysed using SPSS version 21. Study protocol was approved by Institutional Ethics Committee (IEC No: 595/2015).Results: A total of 191 children with sepsis were enrolled in the study of which 40 were excluded. Thrombocytopenia was observed among 67.5% (102/151) of the study population with sepsis. The difference in platelet indices between cases and controls were found to be statistically significant. Mortality rate in the present study was 27.8% (42/151). Platelet count (p=0.003) and plateletcrit (p=0.004) were significantly low among nonsurvivors when compared to survivors with sepsis. Among the children who had thrombocytopenia prior to discharge, severity of thrombocytopenia showed significant relation with the outcome of children with sepsis (p=0.006). Conclusions: In the present study, plateletcrit, mean platelet volume, platelet distribution width and platelet count showed statistically significant relation in children with sepsis when compared to controls. With regard to predicting mortality, platelet count and plateletcrit showed statistically significant lower values among non survivors when compared to survivors.