Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study.
BACKGROUND
Thrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital.


OBJECTIVE
To determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children.


METHODS
Children who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality.


RESULTS
Forty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV × PDW/Platelet count × PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69-10.99), 3.86 (95% CI, 1.53-9.75), 3.45 (95% CI, 1.38-8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45.


CONCLUSIONS
The MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.
Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi.
Zainab Mohammedi
ZM
Golwala
Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi.
Hardik
H
Shah
Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi.
Neeraj
N
Gupta
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi.
V
V
Sreenivas
Department of Pediatrics and Neonatology, St. Stephens Hospital, New Delhi.
Jacob M
JM
Puliyel
D001792:Blood Platelets / Q000473:pathology*; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D063847:Mean Platelet Volume; D015999:Multivariate Analysis; D015539:Platelet Activation; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers
PRISM; SICK Score; in-hospital mortality; platelet indices; severity of illness scores PIM