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Published on: November 8, 2024
Platelet-Derived Biomarkers: Potential Role in Early Pediatric Serious Bacterial Infection and Sepsis Diagnostics
Aiste Pociute1, Muhammed Fazil Kottilingal Farook1, Algirdas Dagys2
1Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Insights
New platelet markers like CXCL7 and sP-selectin show promise in diagnosing serious bacterial infections (SBI) and sepsis in febrile children. These markers, along with clinical signs, can improve early detection in pediatric emergency departments.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Biomarker Discovery
Background:
- Fever is a common pediatric emergency department (PED) complaint, often viral, but differentiating bacterial infections is challenging with standard markers.
- Platelets are increasingly recognized as key players in infection pathogenesis, suggesting their indices and secreted proteins could be valuable diagnostic tools.
- Early diagnosis of serious bacterial infection (SBI) and sepsis in children is critical but hampered by the limitations of traditional inflammatory markers.
Purpose of the Study:
- To evaluate the diagnostic utility of novel platelet indices (platelet-to-neutrophil/lymphocyte ratio [PNLR], platelet-to-neutrophil ratio [PNR]) and specific platelet-secreted proteins (sP-selectin, CXCL4, CXCL7, serotonin) in children with early-onset fever.
- To determine if these markers can differentiate viral infections from bacterial infections, including SBI and sepsis, in a pediatric emergency setting.
- To assess the combined predictive value of these markers with clinical signs like tachypnea and low oxygen saturation (SpO2) for improved sepsis and SBI detection.
Main Methods:
- A cohort of 68 children with fever onset <12 hours presenting to a PED was analyzed.
- Participants were categorized into viral, bacterial, or SBI groups, excluding those with comorbidities or specific age/health conditions.
- Blood samples were collected for analysis of leukocyte counts, neutrophil counts, C-reactive protein (CRP), platelet indices (PNLR, PNR), and specific proteins (sP-selectin, CXCL4, CXCL7, serotonin).
Main Results:
- While leukocyte, neutrophil, and CRP levels differed between SBI and other groups, they remained within age norms.
- Higher PNLR was observed in the bacterial group, and PNR was higher in the viral group.
- CXCL7 and sP-selectin, individually and combined, demonstrated statistically significant ability to discriminate SBI and sepsis from other infections. Their predictive value improved when combined with tachypnea and SpO2 < 94%.
Conclusions:
- CXCL7 and sP-selectin are promising biomarkers for the early diagnosis of SBI and sepsis in febrile children.
- Platelet indices like PNLR and PNR may offer additional insights into infection etiology.
- Integrating novel platelet-derived markers with clinical assessment can enhance the accuracy of early detection for severe infections in pediatric emergency care.
Abstract:
Fever is the most common complaint of children who are attending a pediatric emergency department (PED). Most of the fever cases are of viral origin; however, the most common markers, such as leucocyte, neutrophil count, or C-reactive protein, are not sensitive or specific enough to distinguish the etiology of fever, especially if children present at the early phase of infection. Currently, platelets have been attributed a role as important sentinels in viral and bacterial infection pathogenesis. Thus, our aim was to analyze different platelet indices, such as PNLR (platelet-to-neutrophil/lymphocyte ratio), PNR (platelet-to-neutrophil ratio) as well as specific secreted proteins, such as sP-selectin, CXCL4, CXCL7, and serotonin. We included 68 children who were referred to PED with the early onset of fever (<12 h). All children with comorbidities, older than five years, and psychiatric diseases, who refused to participate were excluded. All the participants were divided into viral, bacterial, or serious bacterial infection (SBI) groups. All the children underwent blood sampling, and an additional sample was collected for protein analysis. Our analysis revealed statistically significant differences between leucocyte, neutrophil, and CRP levels between SBI and other groups. However, leucocyte and neutrophil counts were within the age norms. A higher PNLR value was observed in a bacterial group, PNR-in viral. As we tested CXCL7 and sP-selectin, alone and together those markers were statistically significant to discriminate SBI and sepsis from other causes of infection. Together with tachypnoe and SpO2 < 94%, it improved the prediction value of sepsis as well as SBI. CXCL4 and serotonin did not differ between the groups. Concluding, CXCL7 and sP-selectin showed promising results in early SBI and sepsis diagnosis.
