Platelet Distribution Width to Platelet Count Ratio as an Index of Severity of Illness
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To prospectively validate association between the ratio of platelet distribution width (PDW)/platelet count (PCT) and pediatric intensive care unit (PICU) mortality.
The study was done in the pediatric intensive care unit (PICU). Platelet indices in the first sample taken after admission were used. In this case control analysis, cases were the patients who died in PICU and the survivors served as controls. Consecutive 209 eligible patients over a period of 15 mo from January 2014 through March 2015 were included. Exposure was PDW/PC above 0.07. Of them 174 survived and 35 died.
The mean PDW for survivors was 16.77 (±0.92) and for those who died it was 17.33 (±1.03) (p 0.0015). Mean platelet count (PC) for survivors was 3,46,000 (±1,64,700) and for those who died it was 1,75,800 (±1,61,500) (p < 0.001). PDW/PC for survivors was 0.12 (±0.46) and for those who died it was 0.336 (±0.53) (p 0.0014). Using the cut-off of 0.07 for PDW/PC described by Golwala et al., 77.14% above the cut-off died, compared to 22.85% below that cut-off. The odds ratio (OR) for death was 10.6 (95% CI: 4.48 to 25.12). The area under the receiver operating curve (ROC) curve for PDW/PC ratio was 0.81.
The ratio of PDW/PC, higher than 0.07 in the first sample after admission can be considered as an independent predictor of mortality with sensitivity and specificity of 77.1% and 77.5%, respectively. It may be a useful component for inclusion in composite scores for predicting mortality.
KeywordsPlatelet indices Critical care in pediatrics Predicting mortality in hospital
All the co-authors and hospital staff helped in unified way to make this research work possible. Dr. Purbiya is especially grateful to the head of department, Dr. Jacob M. Puliyel, for providing valuable guidance and support at each step right from conceptualizing the hypothesis to submission of manuscript.
PP: Collected and compiled the data for the study and drafted the manuscript; JMP: Conceptualized and designed the study and finalized the manuscript; ZMG and AM: Provided intellectual inputs from protocol stage and helped in drafting paper; VS: Did the sample size calculation and statistical analysis. All the authors performed critical review. JMP will act as guarantor for the paper.
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