“Platelet indices can be used to monitor the progression and outcomes of sepsis, including recovery or death, in neonates and children.”

Admission platelet count and indices as predictors of outcome in children with severe sepsis: a prospective hospital-based study. ... The association of increased MPV and thrombocytopenia with mortality in one study of sepsis in a PICU setting suggested that in septic children, bone marrow exhaustion may represent an almost preterminal event. IPF was shown to be higher prior to diagnosis of NEC or sepsis compared to previously reported healthy neonates and then declined reaching a nadir 3–5 days following diagnosis.

This meta-analysis evaluates platelet index ratios (mean platelet volume-to-platelet count, MPV/PLT; platelet distribution width-to-platelet count, PDW/PLT; and platelet distribution width-to-plateletcrit, PDW/PCT) as cost-effective biomarkers for sepsis diagnosis and prognosis in resource-constrained settings. For predicting mortality, neonatal sepsis showed higher sensitivity (89%) and specificity (73%) than adult sepsis (63%, 58%). Survivors had significantly lower MPV/PLT ratios than non-survivors in both children/neonate (SMD = 0.67, P < 0.01) and adult group (SMD = 0.41, P < 0.01), with similar trends observed in longitudinal assessments.

The findings suggest that maternal platelet parameters (MPV, PCT and IPF) can be utilized as evidence of early predictors of development of neonatal sepsis and respiratory distress and may be considered as a predictive markers for adverse neonatal outcome. Levels of IPF were also increased in positive neonatal sepsis group (10.11 ± 6.27% Vs 5.06 ± 4.07%; P < 0.001).

Neonatal patients with sepsis had significantly higher MPV levels than do neonates without sepsis (MD 1.26; 95% CI 0.89−1.63; p < 0.001). An increased MPV during the first 24 h postpartum was associated with high CRP values and high risk of neonatal mortality. In the investigations, the MPV cutoff for sepsis patients was 9.95 (SD 0.843). Overall certainty of the evidence was very low. Conclusions: The increased MPV during the first 24 h postpartum may be predictive of EONS and mortality. Future studies are warranted.

MPV of 10.75 fL and above was described as the reference value in sepsis patients, possibly resulting in death at diagnosis (sensitivity - 95.2% and specificity - 84.9%). Our study observations are in line with available literature, which indicates that platelet count, MPV, and PDW and CRP may serve as supportive diagnostic markers in resource-limited settings.

Admission PDW is a fast and specific tool to predict the outcome of children with sepsis. MPV, PDW, and PDW/PLT were significantly higher in non-survivors than survivors (P=0.04, P=0.02, and P=0.04, respectively). PDW was found to be the most specific parameter in predicting death in children with sepsis.

MPV is used in diagnosing, predicting and monitoring the severity of neonatal sepsis. Significant increase in MPV levels compared to base amounts in neonatal sepsis was reported by Guida et al. Thrombocytopenia (platelet count < 150 000/μl) had the highest sensitivity to detect sepsis (87.91%) followed by MPV and PDW with a sensitivity of 84.9% and 79.12%, respectively.

Based on our results and comparison with other studies, we can conclude that commonly used platelet indices (platelet count, MPV, and PDW) are significant predictors of neonatal sepsis in NICU settings. Neonates with confirmed sepsis exhibited severe thrombocytopenia and elevated MPV and PDW, indicating a poor prognosis.

Platelet indices MPV and MPV/TPC ratio can be useful in the early diagnosis of neonatal sepsis. CBC parameters such as low TPC, high MPV, and high MPV to TPC ratio at designated cut-off values serve as important diagnostic markers when used alone or together.

Platelet count and PCT were significantly lower (p < 0.001) and MPV was significantly higher in non-survivor than survivors (p = 0.004). PCT with sensitivity = 94.74%, was the most sensitive platelet parameter for prediction of death, while MPV/PCT was the most sensitive ratio (sensitivity = 94.7%).

Platelet count and indices (MPV, PDW, PCT) were significantly correlated with sepsis, inflammatory burden, and mortality, demonstrating moderate diagnostic accuracy and prognostic value in neonatal sepsis. Non-survivors (n=22) had lower TPC and PCT and higher MPV/PDW than survivors (all p≤0.021).

MPV, PDW, and PDW/PLT were significantly higher in non-survivors than survivors (P=0.04, P=0.02, and P=0.04, respectively). ROC curve analysis showed that PDW had the largest AUC (0.708 [95% CI=0.549–0.866]) with a cut-off value of 14.1%, sensitivity of 63.6%, and specificity of 82.6%. PDW was also the only parameter that significantly affected the outcome of children with sepsis. PDW≥14.1% at admission increases the risk of mortality by 5.7 times.

Platelet count and PCT were significantly lower (p < 0.001) and MPV was significantly higher in non-survivor than survivors (p = 0.004). MPV/PLT, MPV/PCT, PDW/PLT, PDW/PCT ratios were found to be significantly higher in the non-survivors than survivor (p < 0.001 in all). PCT with sensitivity = 94.74%, was the most sensitive platelet parameter for prediction of death, while MPV/PCT was the most sensitive ratio (sensitivity = 94.7%).

The results suggested that MPV (OR = 3.226, P = 0.017 < 0.05) and RDW (OR = 2.058, P = 0.019 < 0.05) were independent predictors for prognosis in preterm neonates with sepsis. Our study found that the RDW level of the non-survivor group was significantly higher than that of the survivor group, suggesting that high RDW was a risk factor for sepsis death.

Our results indicated that patients who had high MPV values both at admission and at 72th hour, higher ∆MPV72h-adm, and low platelet count had higher mortality risk. Septic children who had high MPV levels at admission and whose MPV levels increased during follow up had higher risk of mortality.

The conclusion of this study reinforces the critical role of thrombocytopenia and altered platelet indices as significant biomarkers in neonatal sepsis. Our findings indicate that thrombocytopenia is present in a substantial proportion (80%) of neonates diagnosed with sepsis, with a remarkable association with disease severity and mortality.

In the multivariate logistic regression analysis, higher MPV/platelet ratios at 72h (OR: 7.41; 95% CI: 1.25–43.7; p=0.027) and PDW/platelet ratios at 72h (OR: 2.9; 95% CI: 1.13–7.50; p=0.027) were significant risk factors for mortality. Platelet indices are useful laboratory parameters in septic shock. MPV/PLT and PDW/PLT ratios can be promising reliable markers for 28-day mortality in children with septic shock.

Our findings indicate that thrombocytopenia is present in a substantial proportion (80%) of neonates diagnosed with sepsis, with a remarkable association between severe thrombocytopenia and mortality, where 50% of these neonates succumbed to the condition. Elevated MPV and PDW, alongside decreased PCT, are distinctive features that may serve as early indicators of sepsis severity and predict adverse outcomes.

There is a significant difference in MPV at 72 hours and delta MPV between the two categories. The AUC values of 0.761 and 0.870 indicate that Delta MPV and PRISM 3 scores have moderate to high predictive ability for pediatric sepsis outcome. Platelet indices can help in early identification of the risk of mortality and poor outcomes in patients with severe sepsis.

Thrombocytopenia is frequently observed in septic neonates and is associated with increased severity of illness and poorer outcomes. Among all indices, platelet count and PCT were the most reliable markers, followed closely by MPV and PDW, suggesting that these parameters could serve as cost-effective and rapid diagnostic tools for neonatal sepsis.

Platelet count, MPV, and PDW can serve as effective, rapid diagnostic markers, potentially improving early detection and outcomes in neonatal sepsis. The study confirmed a significant association between platelet count and indices with neonatal sepsis.

This study concluded that platelet indices and CRP levels were valued biomarkers for diagnosing and treating neonatal sepsis. MPV and PDW were significantly elevated in neonates with sepsis compared to the reference value.

We found that the platelet count was lower in patients who died than those who survived. We did not find a difference between the PDW of those who died compared to survivors. We found no difference in the MPV between the dead and the survivors. However, the ratio of MPV/PCT was a better predictor of mortality than platelet count or plateletcrit by themselves.

Multiple peer-reviewed studies, including those in BMC Pediatrics (2020), have shown admission platelet count and indices predict outcomes like mortality in children with severe sepsis, supporting their use for monitoring progression. However, no large-scale RCTs confirm causality or routine clinical guidelines from WHO/CDC endorse them as standard for recovery/death prediction.