Diagnostic value of platelet-lymphocyte ratio for pediatric sepsis: A systematic review and meta-analysis

Early diagnosis of pediatric sepsis remains challenging due to limitations of conventional biomarkers. The platelet-to-lymphocyte ratio (PLR), derived from routine blood tests, has emerged as a potential diagnostic marker. This study aimed to evaluate the diagnostic accuracy of PLR for pediatric sepsis.

A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to March 15, 2026. Studies assessing the diagnostic performance of PLR in pediatric sepsis and reporting sufficient data to construct 2×2 contingency tables were included. Pooled sensitivity and specificity were calculated using a random-effects model. Summary receiver operating characteristic (SROC) analysis and Deeks' funnel plot were performed.

Fifteen studies with 1,980 patients were included. The pooled sensitivity and specificity of PLR for diagnosing pediatric sepsis were 0.81 (95% CI: 0.73-0.87) and 0.72 (95% CI: 0.60-0.82), respectively. The SROC curve demonstrated an area under the curve of 0.79, indicating moderate diagnostic accuracy. Significant heterogeneity was observed. Subgroup analysis showed better performance in larger studies (≥150 patients) and studies using higher PLR cut-offs (>50). Deeks' funnel plot showed no evidence of publication bias (p = 0.536).

Evidence from studies with high-risk of bias indicates that PLR may have moderate diagnostic accuracy for pediatric sepsis and may serve as a simple, cost-effective adjunctive biomarker. Since, most studies were on neonatal population, evidence may not be generalized to older pediatric populations. Further large-scale prospective studies are needed to establish standardized cut-off values and validate its clinical utility.Registration No: PROSPERO (No. CRD420261338676).