Related Experiment Video
Updated: Jul 11, 2026
Routine Screening Method for Microparticles in Platelet Transfusions
Published on: January 31, 2018
Abnormal Platelet-to-Lymphocyte Ratio is Associated with Poor Outcomes in Pediatric Sepsis
Carine S Abi Gerges1, Courtney M Rowan1,2, Francis Pike3
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
High platelet-to-lymphocyte ratio (PLR) in children with sepsis indicates worse outcomes, including higher mortality and need for intensive interventions. This simple index can improve early risk assessment in pediatric sepsis.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Infectious diseases
Background:
- Sepsis is a leading cause of child mortality.
- Early risk assessment is crucial for timely treatment and improved outcomes.
- Systemic immune-inflammatory indices may aid in risk stratification.
Purpose of the Study:
- To investigate the association between systemic immune-inflammatory indices and clinical outcomes in pediatric sepsis patients.
- To evaluate the utility of the platelet-to-lymphocyte ratio (PLR) in predicting sepsis severity and outcomes.
- To assess if PLR improves existing pediatric risk prediction models.
Main Methods:
- Retrospective cohort study at a tertiary children's hospital (2015-2023).
- Included 420 children (0-18 years) admitted with sepsis and available complete blood count with differential.
- Analyzed the association of PLR with mortality, intubation, ECMO, and discharge outcomes.
Main Results:
- The platelet-to-lymphocyte ratio (PLR) was significantly associated with higher mortality.
- Incorporating PLR into the Pediatric Index of Mortality and Pediatric Risk of Mortality-III improved model discrimination for mortality.
- High PLR correlated with increased odds of intubation and ECMO, and decreased likelihood of timely discharge.
Conclusions:
- Elevated PLR at admission is an independent predictor of adverse clinical outcomes in pediatric sepsis.
- PLR enhances the predictive accuracy of established pediatric sepsis risk scores.
- PLR offers a simple, accessible tool for early risk stratification in critically ill children with sepsis.
Objective:
Sepsis remains a major cause of morbidity and mortality in children, necessitating an early risk assessment to prevent delayed treatment and achieve optimal outcomes. This study investigated the association between systemic immune-inflammatory indices and clinical outcomes in children with sepsis.
Design:
Single-center, retrospective cohort study.
Setting:
Pediatric intensive care unit of a tertiary care children's hospital from 2015 to 2023.
Patients:
Children aged 0-18 years admitted with sepsis. Patients were excluded if they lacked a complete blood count with differential on admission.
Results:
In total, 420 patients were included. The platelet-to-lymphocyte ratio (PLR) was associated with higher mortality [hazard ratio 1.001 (1.000-1.002), P = 0.032]. Incorporating PLR into the Pediatric Index of Mortality score improved the model discrimination for mortality (area under the receiver operator characteristic curves 0.705 vs. 0.774; area under the precision-recall curve 0.202 vs. 0.257). Similarly, adding PLR to the Pediatric Risk of Mortality-III improved the area under the receiver operator characteristic curves from 0.648 to 0.697. High PLR was also associated with higher odds of requiring intubation (OR 2.42, P = 0.005) and extracorporeal membrane oxygenation (OR 4.74, P = 0.002) and with decreased subdistribution hazard ratio of extubation, intensive care unit discharge, and hospital discharge alive at 28 days (subdistribution hazard ratio 0.89, 0.72, and 0.76, respectively; all P < 0.005).
Conclusions:
High PLR at admission was independently associated with worse clinical outcomes in pediatric patients with sepsis. Adding PLR to the Pediatric Index of Mortality and Pediatric Risk of Mortality-III enhanced the predictive performance. PLR is a simple and readily available index that may improve early risk stratification in this high-risk population.
