الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 126 |  |  |
| | | from | 126 | | |
Abstract
In the treatment of critically ill and/or injured patients, it is important to detect those who are at high risk for lethal outcome. Major determinant of outcome is intensity of insult (infection, trauma) as well as immunoinflammatory response. Recently, some readily available parameters, originated from routine complete blood count (CBC), have been investigated as potential biomarkers with mixed results and no consensus so far regarding its accuracy and clinical usefulness: neutrophil- to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count (MPV/PC) ratio.
The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that can be used as an indicator of systemic inflammation; the NLR is defined by the absolute number of neutrophils divided by the absolute number of lymphocytes. It is a simple measure that does not add costs to complete blood count laboratory examinations, which are performed routinely in hospitals. The NLR has been tested as a guide for the prognosis of various diseases, such as cancer, community pneumonia and sepsis. This study aimed to assess the role of neutrophil / lymphocyte ratio in diagnosis of sepsis and prognosis of mortality among critically ill children in Pediatric Intensive Care Unit, Menoufia University Hospital.
This was a prospective observational study conducted on 133 children admitted to Pediatric Intensive Care Unit (PICU) of a tertiary center, Faculty of Medicine, Menoufia University during the period study from February 2019 till August 2020.
Inclusion criteria: Any critically ill child from the age of one month to 18 years was eligible for inclusion in the study.
Exclusion criteria: include age under 1 month or older than 18 years, children with aplastic anemia, immunocompromised children, children with oncological disease associated with bone marrow depression. Also, patients who died or were transferred to the general ward within 24h after ICU admission.
Patients were evaluated on admission by routine laboratory biomarkers, including NLR, in addition to mortality predictive scores. Patients were followed up till hospital discharge. The primary outcome was PICU mortality.
Summary
91
Results were summarized as follow:
PRISM mortality risk%, PIM2 mortality risk% and p SOFA scores had a median of 2.3, 2.4 and 5 respectively. Mortality was (20.3%) in our study sample.
Non-survivors had significantly higher CRP level but lower WBC, platelet count, lymphocytes, and albumin level.
Non–survivors had significantly higher frequency of severe sepsis, ARDS, MV, MODs, and ARDS compared with survivors. Mechanical ventilation duration, PRISM, and pSOFA score were also significantly higher among non- survivors.
CRP had the largest area under the curve (ROC) for prediction of mortality followed platelets, then lymphocytes, then albumin. NLR failed to predict mortality with poor sensitivity and specificity.
Mechanical ventilation and low platelet count are independent predictors of mortality.
NLR was positively correlated with PRISM score, ANC, lymphocytes and WBC. Also, lymphocytes were positively correlated with NLR, WBC, platelets and serum albumin. ANC was positively correlated with NLR, WBC and platelet count. Additionally, WBC was positively correlated with NLR, lymphocytes, platelets and ANC.