Platelet-lymphocyte ratio and sepsis outcome in children

  • Ferry Kurniawan Pediatric Department, RSUP Prof. Dr. R.D. Kandou/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
  • Novie Homenta Rampengan Pediatric Department, RSUP Prof. Dr. R.D. Kandou/Universitas Sam Ratulangi
  • Julius Lolombulan Universitas Sam Ratulangi
Keywords: : sepsis; platelet-lymphocyte ratio; PLR; clinical outcomes

Abstract

Background Sepsis is the most common cause of death in infants and children worldwide. Identification of patients with a high risk of death and accurately anticipating outcomes in the early phase is very important in order to provide adequate intervention to the patient. Predictors and scoring systems have been used to determine the prognosis of sepsis n children. The platelet-lymphocyte ratio (PLR), a newly-used marker for inflammation, has received recent attention, as it can act as an indicator in a variety of diseases, including sepsis.

Objective o investigate the relationship between PLR and clinical outcomes in pediatric patients with sepsis.

Methods This study was conducted using an analytic, observational method with a prospective cohort approach in children with sepsis in the Pediatric Intensive Care Unit (PICU) of Prof. Dr. R. D. Kandou Central General Hospital, Manado, North Sulawesi, from February to August 2020. We analyzed patients’ platelet-lymphocyteratio (PLR), mortality rate, and length of stay using SPSS software. The PLR were recorded once within the first 24 hours of PICU admission.

Results Of 96 PICU patients, 87 patients  were eligible for this study. In total, 50 patients (57.47%) died. Mean PLR was 77.53 among sepsis survivors and 157.2 among non-survivors (rpb=0.566, P<0.0001) indicating a strong relationship between PLR and mortality. We also found a strong positive linear relationship between PLR and PICU length of stay.

Conclusion Platelet-lymphocyte ratio is a predictor of sepsis outcomes that can be easily and inexpensively checked. Thus, it can be used in regions with limited health facilities.

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 consideration for diagnosing and managing severe infection 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. Priyatiningsih DR. Karakteristik sepsis di pediatric intensive care unit RSUPN dr. Cipto Mangunkusumo. [dissertation]. [Jakarta]: Fakultas Kedokteran Universitas Indonesia; 2016.
6. 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.
7. Can E, Hamilcikan 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.
8. 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: 10.36106/paripex.
9. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5:4-11. DOI: 10.4161/viru.27372
10. Tayeh O, Taema KM, Eldesouky MI, Omara AA. Urinary albumin/creatinine ratio as an early predictor of the outcome in critically-ill septic patients. Egypt J Crit Care Med. 2016;4:47-55. DOI: 10.1016/j.ejccm.2016.03.002
11. 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.
12. 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.
13. 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. BJHS. 2017;2:191-5. DOI: 10.3126/bjhs.v2i2.18525.
14. Angele MK, Pratschke S, Hubbard WJ, Chaudry IH. Gender differences in sepsis. Virulence. 2014;5:12-9. DOI: 10.4161/viru.26982.
15. 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.
16. 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 pediatric intensive care. Int J Contemp Pediatr. 2019;6:1052-8. DOI: 10.18203/2349-3291.ijcp20191044.
17. Eren MA, Gunes AE, Kirhan I, Sabuncu T. The role of the platelet-lymphocyte ratio and neuthropil-to-lymphocyte ratio in the prediction of lenght and cost of hospital stay in patients with infected diabetic food ulcers: A retrospective comparative study. Acta Orthop Traumatol Turc. 2020;54: 127-31. DOI: 10.5152/j.aott.2020.02.518.
18. El Asmar A, Ghabi E, Saber T, Abou-Malhab C, Aki B, Rassi ZE. Platelet to lymphocyte ratio is correlated with a delay in feeding resumption following a transhiatal esophagectomy with cervical anastomosis. World J Surg Oncol. 2020;18:267. DOI:: 10.1186/s12957-020-02035-y.
Published
2021-11-22
How to Cite
1.
Kurniawan F, Manoppo J, Runtunuwu A, Rampengan N, Lolombulan J. Platelet-lymphocyte ratio and sepsis outcome in children. PI [Internet]. 22Nov.2021 [cited 4Dec.2024];61(6):322-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2618
Section
Emergency & Pediatric Intensive Care
Received 2021-03-13
Accepted 2021-11-22
Published 2021-11-22