The Value Of Platelet Count And Its Dynamic Changes In The Evaluation Of Disease Severity And Prognosis In Children With Sepsis

Objective:To observe the changes of platelet count in early stage of sepsis in children,and to explore the value of platelet count and its dynamic changes in the assessment of disease severity and prognosis.Method:In this single-center retrospective study,children with sepsis admitted to the PICU of Shengjing Hospital from January 2020 to December 2021 were selected and divided into sepsis group,severe sepsis group and septic shock group according to the severity of the disease.Platelet counts at different time points and the change and decline rate of platelet at 48h were compared between different groups.Secondly,the differences in disease severity score and prognosis of children with different platelet levels were observed according to platelet count groups.Finally,the value of platelet count and its change index in predicting 28d death of children with sepsis was investigated by binary Logistics regression.Results:A total of 134 children with sepsis were included in this study,including 45 in the sepsis group and 49 in the severe sepsis group and 40 in the septic shock group.At admission,the median platelet count of each group was sepsis group(389.5×10~9/L),severe sepsis group(189×10~9/L)and septic shock group(212×10~9/L),respectively,and the difference was statistically significant(P=0.001).The median number of decreased platelet at 48h was 0.5×10~9/L in the sepsis group,-4.5×109/L in the severe sepsis group and 48×10~9/L in the septic shock group,respectively,and there was a statistical difference between the groups(P=0.016).The rate of 48h thrombocytopenia in sepsis group(0%),severe sepsis group(-21.2%)and septic shock group(28.7%)was statistically different among the three groups(P=0.03).The hypothrombocytopenia group had higher rates of septic shock(40.7%VS 18.8%),higher p SOFA scores(5 VS 2)and PELOD-2 scores(4.5 VS 2),and higher rates of 28d mortality(24%VS 7.5%)than the normal group.There were differences in p SOFA and PELOD-2 among mild,moderate and severe platelet reduction groups(P<0.05).Platelet levels were lower in the death group than in the survival group(167×10~9/L vs 317×10~9/L),and the number of platelet drops within 48hours(34×10~9/L vs 3×10~9/L)and the rate of decline(36%vs 0%)were higher.The rate of thrombocytopenia at 48 hours was an independent risk factor for predicting death at 28days(OR 1.026,95%CI 1.004-1.047,P=0.014)with a good predictive value(AUC=0.784),its sensitivity was 0.678 and specificity was 0.789 when the cut-off value was 18.9%.Conclusion:Platelet count in children with sepsis and the dynamic change of platelet count 48h after admission can help to evaluate prognosis.