الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infectious diseases are a global health problem, causing many deaths per year. Respiratory infections as well as diarrhea, malaria, measles, and HIV/AIDS are major causes of morbidity and mortality worldwide. Sepsis is also one of the world’s leading causes of death with at least 19 million cases every year, the majority in low- and middle-income countries.
Sepsis is a major cause of morbidity and mortality, and the incidence is rising, probably due to the growing elderly population, antibiotic resistance, immunosuppressive medication and, invasive surgery.
Prognostic score variables have been shown to be effective for the assessment of severe sepsis and septic shock in pediatrics, especially the pediatric index of mortality PIM2 score and the pediatric logistic organ dysfunction PELOD score. Several physiological and blood chemistry parameters are used in daily practice in intensive care units. Simply observing the platelet counts may be very useful for assessing critical patients, especially those with sepsis. However, one single platelet count is not as valuable as sequential platelet counts throughout the course of sepsis.
Mean platelet volume (MPV) is a platelet index that has been available since the 1970s. Since then, other indices of platelets have been introduced, including platelet volume distribution width (PDW) and plateletcrit (PCT). All these indices can be measured by an inexpensive and readily available routine blood count. Mean platelet volume (MPV) is a measurement that describes the average size of platelets in blood. Normal range for MPV is 6.5-11.5 fl. Platelet distribution width (PDW) is an indicator of variation in platelet size. Normal values of PDW are between 8.5 % and 18.5%. Plateletcrit PCT is an expression of a percentage that reflects the volume occupied by platelets in blood or it is the ratio of platelet volume to the total blood volume. PCT is directly related to the platelet count and the platelet size. Normal values of PCT are between 0.16-0.42 %.
In septic shock, most of the coagulation factors are depleted, and platelet count is decreased. A close relationship between sepsis severity and thrombocytopenia has already been documented. MPV is a marker of platelet activation, i.e., a larger platelet volume means both an enzymatically and metabolically more active platelet than a smaller one.
The aim of this work was to find a correlation between platelet indices and mortality in pediatric patients with septic shock.
The current study was carried on 64 pediatric patients aged from1.5 months to 96 months of both sexes with the diagnosis of septic shock admitted to the Pediatric Intensive Care Unit in Alexandria University Children’s Hospital.
The clinical condition of the patients on admission was evaluated using pediatric index of mortality (PIM2) score and daily follow up using the daily pediatric logistic organ dysfunction (PELOD) score to describe multiorgan dysfunction. Laboratory investigations were recorded including platelet indices.
The cases were divided according to fate into 2 groups, survivor group (40 patient 62.5%) and non-survivor group (24 patient 37.5%).
In this study we found no significant difference between survivors and non survivors as regarding to demographic characteristics, length of stay, clinical source of sepsis, CRP and WBC.
At the day of admission, PIM2 score was the only studied parameter that showed significant difference between survivors and non survivors, and was considered as a good predictor of mortality (AUC 0.756).
As regarding platelet count and platelet indices, at the day of admission there was no significant difference between survivors and non survivors and they were not related to mortality. However, after 24 hours of admission platelet count and plateletcrit were significantly lower and continued to decrease over time in non survivors. While MPV and PDW were significantly higher and continued to increase in non survivors. Among platelet indices PDW was the best predictor of mortality followed by MPV (AUC 0780, 0.757 respectively).
PELOD score and serum lactate also showed a significant difference between survivors and non survivors and were considered as predictors of mortality. PELOD score was considered as the best predictor of mortality among all studied parameters followed by PDW and MPV.