Procalcitonin level, neutrophil to lymphocyte count ratio, and mean platelet volume as predictors of organ dysfunction and mortality in children with sepsis

Background Procalcitonin (PCT) level is one of known biomarker in septic diagnosis, but limited studies report its benefit in predicting the outcomes of children with sepsis. Neutrophil to lymphocyte (NLR) and mean platelet volume (MPV) are simple biomarkers of inflammation that can be measured in routine hematological examination which role in predicting organ dysfunction remain unclear. Objective To understand the correlations between PCT level, NLR, and MPV, tested in the first day of admission with outcomes of septic children in intensive care unit. Methods This retrospective cohort study obtained the data from medical record of pediatric patients admitted in PICU and HCU. The PCT, NLR, and MPV levels were assessed in the first day of admission. Organ dysfunction was identified using qSOFA score more than 2 points, assessed at the third day of admission. Results Sixty-nine septic children were reviewed. PCT level correlated significantly with qSOFA score (R= 0.639; P=0.000); as well as with mortality (R=0.747; P=0.000). Receiver operating characteristic (ROC) curve of PCT level had area under curve (AUC) of 0.922 to predict organ dysfunction (cut-off 3.425; sensitivity 95.8%; specificity 52.4%) and AUC of 0.952 to predict mortality (cut-off 21.165; sensitivity 96.4%; specificity 78%). Moreover, NLR correlated significantly with qSOFA (R=0.407; P=0.001), but did not correlate with mortality. The ROC of NLR to predict organ dysfunction was 0.829 (cut-off 3.52; sensitivity 87.5%; specificity 66.7%). There was no correlation between MPV with qSOFA score neither with mortality. Linear regression test showed that PCT level and NLR simultaneously had correlated with qSOFA score (R=0.696; P= 0.000) and mortality (R=0.748; P=0.000). Meanwhile, PCT and MPV simultaneously had correlation with qSOFA score (R=0.688; P=0.000) and mortality (R=0.733; P=0.000). Moreover, NLR and MPV simultaneously had correlation with qSOFA score (R=0.453; P=0.002). All three independent variables (PCT level, NLR, and MPV) simultaneously correlated with qSOFA score (R= 0.744; P=0.000) and mortality (R=0.739; P=0.000). Conclusion There are significant correlations between each, PCT level and NLR with qSOFA score as well as with mortality. There is no correlation between MPV with qSOFA score, neither with mortality. There are significant correlations between PCV level and NLR with or without MPV with qSOFA score as well as with mortality.