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Platelet Distribution Width to Platelet Count Ratio as an Index of Severity of Illness
Pragati Purbiya1,2, Zainab Mohammedi Golwala3, Ayush Manchanda3
1Department of Pediatrics, St Stephens Hospital, Tis Hazari, Delhi, India. Prags.89@gmail.com.
Insights
The ratio of platelet distribution width (PDW) to platelet count (PCT) can predict mortality in the pediatric intensive care unit (PICU). A higher PDW/PCT ratio in initial blood samples indicates a greater risk of death in critically ill children.
Area of Science:
- Critical Care Medicine
- Hematology
- Pediatrics
Background:
- Platelet indices are crucial in assessing critically ill patients.
- The predictive value of the platelet distribution width (PDW)/platelet count (PCT) ratio for pediatric intensive care unit (PICU) mortality requires further validation.
Purpose of the Study:
- To prospectively validate the association between the PDW/PCT ratio and mortality in the PICU.
Main Methods:
- A case-control study was conducted in a PICU.
- Platelet indices from the first blood sample post-admission were analyzed.
- 209 eligible pediatric patients were included, with 35 deaths and 174 survivors.
Main Results:
- The mean PDW/PCT ratio was significantly higher in non-survivors (0.336 ± 0.53) compared to survivors (0.12 ± 0.46).
- A PDW/PCT ratio above 0.07 was associated with a 10.6-fold increased odds of death (95% CI: 4.48 to 25.12).
- The PDW/PCT ratio demonstrated good predictive performance with an AUC of 0.81.
Conclusions:
- The PDW/PCT ratio, exceeding 0.07 in initial samples, serves as an independent predictor of PICU mortality.
- This ratio offers a sensitivity of 77.1% and specificity of 77.5% for predicting mortality.
- The PDW/PCT ratio can be a valuable addition to composite scores for predicting mortality in critically ill children.
Objective:
To prospectively validate association between the ratio of platelet distribution width (PDW)/platelet count (PCT) and pediatric intensive care unit (PICU) mortality.
Methods:
The study was done in the pediatric intensive care unit (PICU). Platelet indices in the first sample taken after admission were used. In this case control analysis, cases were the patients who died in PICU and the survivors served as controls. Consecutive 209 eligible patients over a period of 15 mo from January 2014 through March 2015 were included. Exposure was PDW/PC above 0.07. Of them 174 survived and 35 died.
Results:
The mean PDW for survivors was 16.77 (±0.92) and for those who died it was 17.33 (±1.03) (p 0.0015). Mean platelet count (PC) for survivors was 3,46,000 (±1,64,700) and for those who died it was 1,75,800 (±1,61,500) (p < 0.001). PDW/PC for survivors was 0.12 (±0.46) and for those who died it was 0.336 (±0.53) (p 0.0014). Using the cut-off of 0.07 for PDW/PC described by Golwala et al., 77.14% above the cut-off died, compared to 22.85% below that cut-off. The odds ratio (OR) for death was 10.6 (95% CI: 4.48 to 25.12). The area under the receiver operating curve (ROC) curve for PDW/PC ratio was 0.81.
Conclusions:
The ratio of PDW/PC, higher than 0.07 in the first sample after admission can be considered as an independent predictor of mortality with sensitivity and specificity of 77.1% and 77.5%, respectively. It may be a useful component for inclusion in composite scores for predicting mortality.
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