Abnormal Platelet-to-Lymphocyte Ratio is Associated with Poor Outcomes in Pediatric Sepsis.

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2025-09-09 DOI:10.1097/SHK.0000000000002681

Carine S Abi Gerges, Courtney M Rowan, Francis Pike, Daniel T Cater

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Abstract

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 (PICU) 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: 420 patients were included. The platelet-to-lymphocyte ratio (PLR) was associated with higher mortality [HR:1.001 (1.000-1.002), p:0.032]. Incorporating PLR into the Pediatric Index of Mortality (PIM) score improved the model discrimination for mortality (AUROC 0.705 vs. 0.774; AUPRC 0.202 vs 0.257). Similarly, adding PLR to the PRISM-III improved AUROC 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 sub distribution hazard of extubation, ICU discharge, and hospital discharge alive at 28 days (SHR: 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 PIM and PRISM III enhanced the predictive performance. PLR is a simple and readily available index that may improve early risk stratification in this high-risk population.

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血小板与淋巴细胞比例异常与儿童败血症预后不良相关

目的：脓毒症仍然是儿童发病和死亡的主要原因，有必要进行早期风险评估，以防止延迟治疗并获得最佳结果。本研究探讨了儿童败血症的全身免疫炎症指数与临床结局之间的关系。设计：单中心、回顾性队列研究。环境：2015 - 2023年三级儿童医院儿科重症监护病房（PICU）。患者：0-18岁儿童败血症入院。如果患者在入院时缺乏全血细胞计数，则排除在外。结果：纳入420例患者。血小板与淋巴细胞比率（PLR）与较高的死亡率相关[HR:1.001 (1.000-1.002), p:0.032]。将PLR纳入儿童死亡率指数（PIM）评分提高了模型对死亡率的判别（AUROC为0.705 vs. 0.774； AUPRC为0.202 vs. 0.257）。同样，将PLR添加到PRISM-III将AUROC从0.648提高到0.697。高PLR还与需要插管（OR 2.42, p:0.005）和体外膜氧合（OR 4.74, p:0.002）的几率较高以及拔管、ICU出院和28天活产出院的亚分布风险降低相关（SHR分别为0.89、0.72和0.76，均p < 0.005）。结论：儿童脓毒症患者入院时的高PLR与较差的临床结果独立相关。在PIM和PRISM III中加入PLR可提高预测性能。PLR是一种简单易行的指标，可以改善这类高危人群的早期风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.