Evaluating the significance of platelet count, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in critically ill children

Abstract When critically ill pediatric patients are admitted to the pediatric intensive care unit (PICU), they may face significant morbidity and mortality. Therefore, it is essential to identify at-risk patients early to manage their conditions promptly and navigate through the complexities of their illnesses. This study aims to evaluate the prognostic value of platelet count, Neutrophil/Lymphocyte ratio (NLR) and the Platelets/Lymphocyte ratio (PLR) in children undergoing medical care in the PICU.Over a period of 6 months, a prospective study involving 91 PICU patients was conducted. Upon admission, patients underwent detailed history-taking, comprehensive systemic evaluations, and standard laboratory tests that encompassed complete blood counts, C-reactive protein levels, coagulation profiles, as well as liver and kidney function assessments. Subsequently, the NLR and PLR values were determined. The median NLR was slightly elevated in non-survivors compared to survivors, whereas the PLR was higher in survivors, although these differences were not statistically significant. Platelet levels emerged as a predictive factor for mortality, with an AUC of 0.748, a cutoff value of 244.5, and a p-value of 0.002. Additionally, NLR showed a negative correlation with the Glasgow coma score and a positive correlation with age, TLC, CRP, and ALT, with correlation coefficients of ( r =-0.253, p = 0.016), ( r = 0.320 , p = 0.002), ( r = 0.292, p = 0.005), ( r = 0.242 , p = 0.027), and ( r = 0.256 , p = 0.028) respectively. While no statistically significant relationship was observed between NLR and PLR and non-survivors, platelet count showed moderate discriminatory performance for prognostic evaluation and may be used as part of early risk stratification in critically ill patients.