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Evaluation of Complete Blood Count Parameters for Diagnosis In Original Investigation / Özgün Araştırma DOI: 10.5578/ced.68886 • J Pediatr Inf 2020;14(2):e55-e62 Evaluation of Complete Blood Count Parameters for Diagnosis in Children with Sepsis in the Pediatric Intensive Care Unit Pediatrik Yoğun Bakım Ünitesinde Sepsisli Çocuklarda Tanı İçin Tam Kan Sayımı Parametrelerinin Değerlendirilmesi Fatih Aygün1(İD), Cansu Durak1(İD), Fatih Varol1(İD), Haluk Çokuğraş2(İD), Yıldız Camcıoğlu2(İD), Halit Çam1(İD) 1 Department of Pediatric Intensive Care, Istanbul University School of Cerrahpasa Medicine, Istanbul, Turkey 2 Department of Pediatric Infectious Diseases, Istanbul University School of Cerrahpasa Medicine, Istanbul, Turkey Cite this article as: Aygün F, Durak C, Varol F, Çokuğraş H, Camcıoğlu Y, Çam H. Evaluation of complete blood count parameters for diagnosis in children with sepsis in the pediatric intensive care unit. J Pediatr Inf 2020;14(2):e55-e62. Abstract Öz Objective: Early diagnosis of sepsis is important for effective treatment Giriş: Erken tanı sepsiste etkili tedavi ve iyi prognoz için önemlidir. C-re- and improved prognosis. C-reactive protein (CRP) and procalcitonin aktif protein (CRP) ve prokalsitonin (PKT) sepsiste en sık kullanılan bi- (PCT) are the most commonly used biomarkers for sepsis. However, their yobelirteçlerdir. Fakat rutinde kullanımı maliyet etkin değildir. Tam kan routine usage is not cost-effective. Complete Blood Count (CBC) param- sayımı (TKS) parametrelerinden eritrosit dağılım genişliği (EDG), nötrofil eters including red cell distribution width (RDW), neutrophil to lympho- lenfosit oranı (NLO), trombosit lenfosit oranı (TLO), ortalama trombosit cyte ratios (NLR), platelet to lymphocyte ratios (PLR), mean platelet vol- hacmi (OTH) basit ve kolay olarak hesaplanmaktadır. Bu çalışmanın ama- ume (MPV), and hemoglobin are simple and easily calculated. The aim of cı sepsisli hastalarda başvurudaki TKS parametrelerinin incelenmesi ve this study was to determine the CBC parameters in patients with sepsis kontrol grubu ile karşılaştırılmasıdır. on admission and compare with those of the control group. Gereç ve Yöntemler: Ocak 2014-Mart 2019 tarihleri arasında çocuk yo- Material and Methods: The medical records of 115 eligible patients ğun bakım ünitesinde yatırılan çalışma için uygun olan 115 (68’i sepsis, (68 sepsis, 47 control patients) who were hospitalized in PICU between 47’si kontrol) hastanın tıbbi kayıtları geriye dönük olarak incelendi. Sep- January 2014 and March 2019 were retrospectively investigated. Demo- sis tanısı ile başvuran hastaların demografik, prognostik ve laboratuvar graphic, prognostic and laboratory findings of the patients admitted bulguları kontrol hastaları ile karşılaştırıldı. with sepsis were compared with those of the control patients. Bulgular: Altmış sekiz (%59.1) hasta sepsis, ağır sepsis veya septik şok Results: Sixty-eight (59.1%) of the patients were admitted with sepsis, tanılarıyla başvurmuştu. Sepsisli hastalarda kontrol grubuna göre CRP severe sepsis or septic shock. In sepsis patients, CRP (p< 0.001), leukocyte (p< 0.001), lökosit sayısı (p= 0.004), OTH (p< 0.001), EDG (p< 0.001) daha count (p= 0.004), MPV (p< 0.001), RDW (p< 0.001) were higher and plate- yüksek, trombosit sayısı (p= 0.016) daha düşüktü, aralarındaki fark ista- let count (p= 0.016) was lower than the control group, the difference was tistiksel olarak anlamlıydı. ROC eğrisi analizi sonucunda CRP için kesme statistically significant. Analysis of ROC curves showed that CRP, at a cut off value 0.66 mg/dL, had a sensitivity of 82.4% and a specificity of 70.2%. değeri 0.66 mg/dL olup %82.4 duyarlı ve %70.2 özgüldü. EDG için du- RDW showed 76.5% sensitivity and 76.6% specificity (cut off: 14.55%); yarlılık %76.5, özgüllük %76.6 (kesme değeri: %14.55), hemoglobin için hemoglobin showed 83.0% sensitivity and 72.3% specificity (cut off: 10.9 duyarlılık %83.0, özgüllük %72.3 (kesme değeri: 10.9 g/dL) idi. Korelas- g/dL). Correlation analysis showed positive correlation between sepsis yon analizi sonucu sepsis ile CRP (r= 0.627, p< 0.001) ve EDG (r= 0.585, and CRP (r= 0.627, p< 0.001) and RDW (r= 0.585, p< 0.001), and a nega- p< 0.001) arasında pozitif, hemoglobin (r= -0.562, p< 0.001) ile negatif tive correlation with hemoglobin (r= -0.562, p< 0.001). In logistic regres- yönlü bir korelasyon saptandı. Lojistik regresyon analizinde, EDG’nin her bir sayısal artışı sepsis olma olasılığını 2.094 kat arttırmaktadır. Correspondence Address/Yazışma Adresi Fatih Aygün İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Çocuk Yoğun Bakım Bilim Dalı, İstanbul-Türkiye E-mail: [email protected] ©Copyright 2020 by Pediatric Infectious Diseases and Immunization Society. Received: 26.06.2019 Accepted: 07.11.2019 Available Online Date: 04.08.2020 Available online at www.cocukenfeksiyon.org Aygün et al. e56 Hemogram is Important for Sepsis J Pediatr Inf 2020;14(2):e55-e62 sion analysis, each numerical increase of RDW increases the probability of Sonuç: Başvuru EDG, OTH, trombosit ve hemoglobin değerleri çocuk having sepsis by 2.094 fold. yoğun bakım ünitesinde sepsis ile ilişkilidir. Bu parametreler kritik hasta Conclusion: Admission RDW, MPV, platelet, and hemoglobin values are çocuklarda sepsis teşhisi için uygun maliyetli, kullanışlı ve kolay erişilebilir related with sepsis in the PICU. These parameters are cost effective, use- testlerdir. Fakat EDG tek başına sepsis tanısı için yeterli olmayabilir. ful, and easily accessible tests for diagnosing sepsis in critically-ill children. Anahtar Kelimeler: Hemoglobin, nötrofil lenfosit oranı, eritrosit dağılım However, RDW alone may not provide sufficient evidence for the diagno- hacmi, ortalama trombosit hacmi, prokalsitonin, C-reaktif protein sis of sepsis. Keywords: Hemoglobin, neutrophil/lymphocyte ratio, red distributions width, mean platelet volume, sepsis, procalcitonin, C-reactive protein Introduction The study was conducted in accordance with the Decla- ration of Helsinki, and informed consent was obtained from Accurate and early diagnosis is important to initiate effec- parents or legal guardians of the patients when they were ad- tive treatment and improve the prognosis of sepsis. Therefore, a mitted to the PICU. The local ethics committee (Ethical com- large number of biomarkers have been developed for the diag- mittee, no: 29430533-903.99-109967, December 13, 2018) nosis of sepsis. Unfortunately, none of these biomarkers exhibit approved the study. a high degree of sensitivity and specificity. The most common We have recorded all materials, data, computer codes, and of these markers is C-reactive protein (CRP), which is a major protocols associated with the publication for readers. acute-phase reactant in infection and inflammation (1). Anoth- er important biomarker of sepsis is procalcitonin (PCT). PCT Patient Population and Data Collection levels are undetectable in the plasma of healthy people and Demographic data, reason for hospitalization, underlying increases in serious bacterial infections (2). Interleukin-6 (IL6), chronic diseases, and initial CBC and CRP were recorded. For which is a cytokine released during inflammatory processes, CBC measurements, peripheral blood was collected using an is an another commonly used biomarker (3). However, routine EDTA vacutainer tube and analyzed with an automated blood measurements of these biomarkers are not cost effective. cell counter (Cell-Dyn 3700, USA). NLR ratio and PLR were cal- Recent literature focuses on CBC parameters that are easy culated as the ratio of neutrophils to lymphocytes and plate- to evaluate and routinely analyzed. White blood cell (WBC), lets to lymphocytes, respectively. neutrophil (N), lymphocyte (L), platelet counts, neutrophil to Age, sex, invasive or noninvasive mechanical ventilation, lymphocyte ratios (NLR), red cell distribution width (RDW), he- inotropic drugs, blood component transfusions, continuous moglobin, mean platelet volume (MPV), and platelet to lym- renal replacement therapy (CRRT), intensive care duration, phocyte ratios (PLR) are low-cost and easily calculated CBC the pediatric risk of mortality (PRISM) score, and laboratory tests. Since these parameters are affected by many inflamma- findings at admission were accepted as possible risk factors tory conditions, there are various studies regarding the impor- of sepsis, and they were recorded (Table 1). The demograph- tance of CBC parameters in the prognosis of sepsis. Herein, we ic, prognostic, and laboratory findings of patients admitted aimed to evaluate the possible association between early diag- with sepsis were compared to patients with control patients. nosis of sepsis and CBC parameters in a PICU. We used patients who were admitted for drug intoxications as Materials and Methods controls. These patients were taken as the control group con- sidering that there would be no change on admission blood Study Design values. There was no hematological drug intoxication in these Healthcare provision for children aged from 1 month to 18 patients. years is provided in our PICU, which is equipped with 7 beds, 7 Ninety-five (15.6%) of the patients in this study were di- ventilators, and 2 isolation rooms. The data of all patients (n= agnosed with sepsis. Twenty-seven of them were excluded 607) admitted to the PICU for various critical illnesses between because of underlying diseases and hospitalization time. For- January 2014 and March 2019 were extracted from electronic ty-seven of the 607 patients were admitted to the PICU with and written medical records (in accordance with
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