Platelet-to-lymphocyte ratio, PELOD-2 score, and mortality rate in pediatric sepsis

  • Novie Homenta Rampengan Pediatric Department, RSUP Prof. Dr. R.D. Kandou/Universitas Sam Ratulangi
  • Gregory Joey Universitas Sam Ratulangi
  • Ferry Kurniawan Universitas Sam Ratulangi
  • Jeanette I. Ch. Manoppo Pediatric Department, RSUP Prof. Dr. R.D. Kandou/Universitas Sam Ratulangi
  • Ari Lukas Runtunuwu Pediatric Department, RSUP Prof. Dr. R.D. Kandou/Universitas Sam Ratulangi
DOI: https://doi.org/10.14238/pi61.4.2021.186-91
Keywords: PLR, Sepsis, Pediatric, Mortality Rate, PELOD-2

Abstract

Background Sepsis is life-threatening organ dysfunction caused by a regulated immune response to infection. Sepsis remains the most common cause of death in infants and children worldwide. The Pediatric Logistic Organ Dysfunction (PELOD-2) score, one of the most widely used scoring systems in pediatric sepsis patients, has been shown to be accurate in predicting mortality. The platelet-to-lymphocyte ratio (PLR) is a new clinical indicator of inflammation in a variety of diseases including sepsis.

Objective To investigate the relationship between PLR, PELOD-2 score, and clinical outcomes in pediatric patients with sepsis.

Methods This retrospective cohort study was conducted in the Pediatric Intensive Care Unit (PICU), Prof R.D. Kandou Hospital, Manado, North Sulawesi, from February to August 2020. Subjects’ PELOD-2 score and PLR were recorded once within the first 24 hours of PICU admission. We analyzed patients’ PELOD-2 score, PLR, and mortality rate, with 95% confidence interval (CI) for each value.

Results Of 96 children with sepsis admitted to the PICU during the study period, 87 patients (46 boys; 52.9%) met the inclusion criteria. In total, 50 (57.47%) patients were non-survivors. Mean PLR values among survivors [77.54 (SD 50.08)] was significantly lower compared to the values among non-survivors [157.13 (SD 67.38)]; as well as the PELOD-2 score in the survivors group [12 (SD 1.32)] was significantly lower than its value in the non-survivors [14.65 (SD 2.09)]. Spearman’s analysis showed a moderately positive correlation between PLR and PELOD-2 score (r=0.444; 95%CI 0.44 to 1; P<0.01). Biserial point correlation analysis revealed a significant association between PLR and mortality rate (rpb=0.566; P<0.0001),with elevated PLR related to an increased risk of mortality.

Conclusion There are positive correlations between PLR, PELOD-2 score, and mortality rate in pediatric patients with sepsis. Higher PLR and PELOD-2 score are associated with higher mortality.

References

1. Somasetia DH. Pedoman nasional diagnosis dan tata laksana sepsis pada anak. In: Daud D, Rauf S, Salakede SB, Lawang SA. Kumpulan makalah pertemuan ilmiah tahunan VIII. 1st ed. Makassar: Departemen Ilmu Kesehatan Anak FK UNHAS; 2016. p. 3-17.
2. Hadinegoro SR, Chairulfatah A, Latief A, Pudjiadi AH, Malisie RF, Alam A. Konsensus diagnosis dan tata laksana sepsis pada anak. 1st ed. Jakarta: IDAI; 2016. p. 1-47.
3. Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children and adolescents. Virulence. 2014;5:179-89. DOI: 10.4161/viru.27045.
4. Vincent JL, Pereira AJ, Gleeson J, De Backer D. Early management of sepsis. Clin Exp Emerg Med. 2014;1:3-7. DOI: 10.15441/ceem.14.005.
5. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC, et al. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 1:167(5):695-701. DOI: 10.1164/rccm.200207-682OC
6. Priyatiningsih DR. Karakteristik sepsis di pediatric intensive care unit RSUPN dr. Cipto Mangunkusumo. [dissertation]. [Jakarta]: Fakultas Kedokteran Universitas Indonesia; 2016.
7. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open. 2019;9:e022896.DOI: 10.1136/bmjopen-2018-022896.
8. Can E, Hamilcukan S, Can C. The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for detecting early-onset neonatal sepsis. J Pediatr Hematol Oncol. 2018;40:e229-32.DOI: 10.1097/MPH.0000000000001059.
9. Bharadwaj N, Singh HB, Anjum S, Tadury A. Does the platelet to neutrophil ratio and platelet to lymphocyte ratio predict newborn sepsis a case control study? Paripex Indian J Res. 2018;7:192-3.DOI:10.15296/ijwhr.2021.14.
10. Yildiz A, Yigit A, Benli AR. The prognostic role of platelet to lymphocyte ratio and mean platelet volume in critically ill patients. Eur Rev Med Pharmacol Sci. 2018;22:2246-52. DOI: 10.26355/eurrev_201804_14811.
11. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5:4-11. DOI: 10.4161/viru.27372.
12. Tayeh O, Tema KM, Eldesouky MI, Omara AA. Urinary albumin/creatinine ratio as an early predictor of outcome in critically-ill septic patients. Egyptian J Crit Care Med. 2016;4:47-55. DOI: 10.1016/j.ejccm.2016.03.002.
13. Ed Rainger G, Chimen M, Harrison MJ, Yates CM, Harrison P, Watson SP, et al. The role of platelets in the recruitment of leukocytes during vascular disease. Platelets. 2015;26:507–20. DOI: 10.3109/09537104.2015.1064881.
14. Page C, Pitchford S. Neutrophil and platelet complexes and their relevance to neutrophil recruitment and activation. Int Immunopharmacol. 2013;17:1176–84. DOI: 10.1016/j.intimp.2013.06.004.
15. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348:138DOI: 10.1056/NEJMra021333.
16. Wesche DE, Lomas-Neira JL, Perl M, Chung CS, Ayala A. Leukocyte apoptosis and its significance in sepsis and shock. J Leukoc Biol. 2005;78:325-37.DOI: 10.1189/jlb.0105017.
17. Thapa S, Prasad PN, Shakya YM. Serum lactate-albumin ratio as predictor of mortality in severe sepsis and septic shock at Tribhuwan University Teaching Hospital, Kathmandu. Birat J Health Sci. 2017;2:191-5. DOI: 10.3126/bjhs.v2i2.18525.
18. Angele MK, Pratschke S, Hubbard WJ, Chaudry IH. Gender differences in sepsis: cardiovascular and immunological differences. 2014;5:12-9. DOI: 10.4161/viru.26982.
19. Karagoz I, Yoldas H. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratios as strong predictors of mortality in intensive care population. Rev Assoc Med Bras. 2019;65:633-6. DOI: 10.1590/1806-9282.65.5.633.
20. Mathews S, Rajan A, Soans ST. Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in paediatric intensive care. Int J Contemp Pediatr. 2019;6:1052-8. DOI: 10.18203/2349-3291.ijcp20191044.
21. Misirlioglu M, Bekdas M, Kabakus N. Platelet to lymphocyte ratio in predicting mortality of patients in pediatric intensive care unit. J Clin Anal Med. 2018;9:488-92. DOI: 10.4328/JCAM.5809
22. Uslu AU, Kucuk A, Sahin A, Ugan Y, Yilmaz R, Gungor T, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis. 2015;18:731-5. DOI: 10.1111/1756-185X.12582.
23. Seo YJ, Joeng JH, Choi JY, Moon IS. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: Novel markers for diagnosis and prognosis in patients with idiopathic sudden sensorineural hearing loss. Dis Markers. 2014;2014:702807. DOI: 10.1155/2014/702807.
24. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17:391-6. DOI: 10.1111/hdi.12040.
25. Kim EY, Lee JW, Yoo HM, Park CH, Song KY. The platelet-to-lymphocyte ratio versus neutrophil-to-lymphocyte ratio: which is better as a prognostic factor in gastric cancer? Ann Surg Oncol. 2015;22:4363-70. DOI: 10.1245/s10434-015-4518-z.
26. Karagoz I, Yoldas H. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratios as strong predictors of mortality in intensive care population. Rev Assoc Med Bras. 2019;65:633-6. DOI: 10.1590/1806-9282.65.5.633.
Published
2021-08-16
How to Cite
1.
Rampengan N, Joey G, Kurniawan F, Manoppo J, Runtunuwu A. Platelet-to-lymphocyte ratio, PELOD-2 score, and mortality rate in pediatric sepsis. PI [Internet]. 16Aug.2021 [cited 20Apr.2024];61(4):186-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2605
Issue
Vol 61 No 4 (2021): July 2021
Section
Emergency & Pediatric Intensive Care

Copyright (c) 2021 Novie Homenta Rampengan, Gregory Joey, Ferry Kurniawan, Jeanette I. Ch. Manoppo, Ari Lukas Runtunuwu

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Received 2021-02-23
Accepted 2021-08-16
Published 2021-08-16