Download PDF
J Pediatr Intensive Care 2023; 12(03): 228-234
DOI: 10.1055/s-0041-1731434
Original Article

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children

Madhuradhar Chegondi 
1   Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
,
Niranjan Vijayakumar 
1   Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
,
Ramya Deepthi Billa
1   Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
,
Aditya Badheka 
1   Division of Pediatric Critical Care Medicine, Stead Family Children's Hospital, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
,
Oliver Karam 
2   Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Platelet mass index (PMI) as a prognostic indicator in pediatric sepsis has not been previously reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data from 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55–0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59–0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies should be performed to assess its clinical value.

Keywords

platelet mass index - area under curve - sensitivity and specificity - septic shock - children


Publication History

Received: 30 March 2021

Accepted: 20 May 2021

Article published online:
22 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Weiss SL, Fitzgerald JC, Pappachan J. et al; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 2015; 191 (10) 1147-1157
    CrossrefPubMedGoogle Scholar
  • 2 Sehgal M, Ladd HJ, Totapally B. Trends in epidemiology and microbiology of severe sepsis and septic shock in children. Hosp Pediatr 2020; 10 (12) 1021-1030
    CrossrefPubMedGoogle Scholar
  • 3 Seymour CW, Liu VX, Iwashyna TJ. et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (08) 762-774
    CrossrefPubMedGoogle Scholar
  • 4 Schlapbach LJ, Kissoon N. Defining pediatric sepsis. JAMA Pediatr 2018; 172 (04) 312-314
    CrossrefPubMedGoogle Scholar
  • 5 Gulla KM, Sachdev A. Illness severity and organ dysfunction scoring in pediatric intensive care unit. Indian J Crit Care Med 2016; 20 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 6 Vardon-Bounes F, Ruiz S, Gratacap M-P, Garcia C, Payrastre B, Minville V. Platelets are critical key players in sepsis. Int J Mol Sci 2019; 20 (14) E3494
    CrossrefPubMedGoogle Scholar
  • 7 Rondina MT, Brewster B, Grissom CK. et al. In vivo platelet activation in critically ill patients with primary 2009 influenza A (H1N1). Chest 2012; 141 (06) 1490-1495
    CrossrefPubMedGoogle Scholar
  • 8 Gao Y, Li Y, Yu X. et al. The impact of various platelet indices as prognostic markers of septic shock. PLoS One 2014; 9 (08) e103761
    CrossrefPubMedGoogle Scholar
  • 9 Sayed SZ, Mahmoud MM, Moness HM, Mousa SO. Admission platelet count and indices as predictors of outcome in children with severe sepsis: a prospective hospital-based study. BMC Pediatr 2020; 20 (01) 387
    CrossrefPubMedGoogle Scholar
  • 10 Zhang Z, Xu X, Ni H, Deng H. Platelet indices are novel predictors of hospital mortality in intensive care unit patients. J Crit Care 2014; 29 (05) 885.e1-885.e6
    CrossrefPubMedGoogle Scholar
  • 11 Ilhan O, Bor M. Platelet mass index and prediction of severity of transient tachypnea of the newborn. Pediatr Int (Roma) 2019; 61 (07) 697-705
    CrossrefPubMedGoogle Scholar
  • 12 Okur N, Buyuktiryaki M, Uras N. et al. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?. J Matern Fetal Neonatal Med 2016; 29 (19) 3218-3222
    CrossrefPubMedGoogle Scholar
  • 13 Girgin R, Cinar O, Bulut E, Akduman B, Mungan NA. The role of the platelet mass index (PMI) as a new prognostic factor in Fournier's gangrene. Afr J Urol 2018; 24 (03) 226-232
    CrossrefPubMedGoogle Scholar
  • 14 Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
    CrossrefPubMedGoogle Scholar
  • 15 Safari S, Baratloo A, Elfil M, Negida A. Evidence based emergency medicine; Part 5 receiver operating curve and area under the curve. Emergency (Tehran) 2016; 4 (02) 111-113
    PubMedGoogle Scholar
  • 16 de Stoppelaar SF, van 't Veer C, van der Poll T. The role of platelets in sepsis. Thromb Haemost 2014; 112 (04) 666-677
    PubMedGoogle Scholar
  • 17 Kim CH, Kim SJ, Lee MJ. et al. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock. PLoS One 2015; 10 (03) e0119437
    CrossrefPubMedGoogle Scholar
  • 18 Choi SJ, Ha E, Jhang WK, Jong Park S. Platelet indices as predictive markers of prognosis in pediatric septic shock patients. Iran J Pediatr 2017; 27 (03) e7212
    PubMedGoogle Scholar
  • 19 Tajarernmuang P, Phrommintikul A, Limsukon A, Pothirat C, Chittawatanarat K. The role of mean platelet volume as a predictor of mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Res Pract 2016; 2016: 4370834
    PubMedGoogle Scholar
  • 20 Kahvecioglu D, Erdeve O, Alan S. et al. The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns. J Matern Fetal Neonatal Med 2014; 27 (17) 1787-1789
    CrossrefPubMedGoogle Scholar
  • 21 Weiss SL, Peters MJ, Alhazzani W. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med 2020; 46 (Suppl. 01) 10-67
    CrossrefPubMedGoogle Scholar
  • 22 Tyagi P, Tullu MS, Agrawal M. Comparison of pediatric risk of mortality , Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in predicting mortality in a pediatric intensive care unit. J Pediatr Intensive Care 2018; 7 (04) 201-206
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Ruth A, McCracken CE, Fortenberry JD, Hall M, Simon HK, Hebbar KB. Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatr Crit Care Med 2014; 15 (09) 828-838
    CrossrefPubMedGoogle Scholar
  • 24 Singer M, Deutschman CS, Seymour CW. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (08) 801-810
    Google Scholar
  • 25 Menon K, Schlapbach LJ, Akech S. et al. Pediatric Sepsis Definition-A Systematic Review Protocol by the Pediatric Sepsis Definition Taskforce. Crit Care Explor 2020; 2 (06) e0123
    CrossrefPubMedGoogle Scholar