Hematological Indices for Identifying Adverse Outcomes in Children Admitted to Pediatric ICUs
Sivakumar Mahalingam1, Vikram Bhaskar1, Prerna Batra2
1Pediatrics, University College of Medical Sciences, Delhi, IND.
Insights
Hematological indices like platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) show potential for predicting mortality in pediatric intensive care units (PICUs). Further research is needed to validate their use in children.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Biomarker research
Background:
- Pediatric Intensive Care Units (PICUs) face higher mortality rates in developing nations.
- Early identification of critically ill children is crucial for preventing deaths.
- Hematological indices like PLR and NLR are used in adults but lack pediatric validation.
Purpose of the Study:
- To evaluate the effectiveness of hematological indices in predicting mortality among children admitted to the PICU.
- To assess the role of platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and platelet count to mean platelet volume ratio (PLT/MPV) in identifying adverse outcomes.
Main Methods:
- Prospective, observational study at a tertiary care hospital.
- Enrolled children aged 1-12 years admitted to the PICU.
- Excluded patients with recent blood product transfusion, chronic medications affecting bone marrow, or known hematological disorders.
Main Results:
- Out of 275 patients, 119 (43.3%) expired.
- PLR demonstrated high sensitivity (85.71%) and NLR showed high specificity (92.31%) for mortality prediction.
- No significant area under the curve (AUC) was observed for these parameters; PLT/MPV showed limited predictive value.
Conclusions:
- Hematological parameters are globally utilized for ICU mortality prediction.
- PLR and NLR are cost-effective biomarkers, with ratios potentially superior to individual markers.
- Further studies with stratified samples are necessary to confirm the role of hematological markers in pediatric PICU mortality risk assessment.
Background:
The pediatric ICU (PICU) is a specialized area where critically sick children are managed. The mortality rates in PICUs are higher in developing countries as compared to developed nations. Many of these deaths could be prevented if very sick children were identified soon after they arrived at the health facility. Hematological indices like platelet lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) have been frequently used in adults as indicators of mortality. However, their use in the pediatric population is limited due to a lack of validated reference intervals.
Objective:
The objective of the study is to assess the role of hematological indices in identifying adverse outcomes in terms of mortality in children admitted to the PICU.
Materials And Methods:
It is a prospective, observational study done at a tertiary care hospital. All children aged one year to 12 years admitted to the PICU were enrolled in the study. A sample for complete blood count was taken within one hour of admission to the PICU. Children who had received blood products in the last two months, those on chronic medications (>two weeks) that can affect bone marrow cellularity, and known cases of hematological disorders such as megaloblastic anemia, hematological malignancies, immune thrombocytopenia, and aplastic anemia were excluded from the study. PLR, NLR, and platelets to mean platelet volume ratio (PLT/MPV) were determined and compared among the survivors and non-survivors.
Results:
Out of 275 enrolled patients, 119 (43.3%) patients expired during the study period. While PLR had high sensitivity and NLR had high specificity (85.71% and 92.31%, respectively) for predicting mortality, none of these parameters had a good area under the curve (AUC) in our study. PLT/MPV of ≥32 had a sensitivity of 39.5% and a specificity of 56.41% for predicting mortality.
Conclusions:
Hematological parameters have been used across the world to predict ICU mortality. PLR and NLR are simple hematological biomarkers, easy to calculate, and cost-effective, and ratios are better than individual parameters. More studies and stratified samples are required to evaluate the role of hematological markers in identifying the risk of mortality in children admitted to PICUs.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention