Introduction: In resource-constrained settings (RCS), advanced laboratory diagnostics during pediatric critical illness remain limited. Hematologic parameters like platelet/lymphocyte ratio (PLR) and white cell/platelet ratio (WPR) have shown correlation with disease severity in adults and neonates, and may be cost-effective prognostic tools. This secondary analysis of the Global PARITY point prevalence study evaluated the relationship between these two hematologic ratios and clinical outcomes among pediatric patients with sepsis and malaria in RCS. Methods: We calculated PLR and WPR based on availability, from admission complete blood counts of patients with sepsis and malaria from Global PARITY’s 46 RCS sites in 19 countries. Sepsis was defined per clinician diagnosis. Clinical outcomes included mortality and organ dysfunction, using established severity scores (LODS, LqSOFA). Statistical analyses included Mann-Whitney U tests for continuous variables, chi-square for categorical comparisons across quartiles, and Spearman/Pearson correlation analyses with severity scores. Results: In the sepsis cohort (n=660), among 295 patients with PLR data, non-survivors (n=9) had significantly higher PLR compared to survivors (n=286): 168.71 vs 91.94; P=0.02 and lower lymphocyte counts (2.29 vs 3.94; P=0.02). Mortality from sepsis increased from 0% in the lowest to a combined 77.7% in the higher PLR quartiles, while WPR did not correlate with mortality outcome in this group. PLR did not correlate with the severity scores in this group. In the malaria cohort (n=175), among 91 patients with WPR data, non-survivors (n=6) had significantly higher WPR compared to survivors (n=85): 0.15 vs 0.06; P=0.01 and lower platelet counts (52 vs 204; P< 0.01). All the malaria mortalities occurred in the higher WPR quartiles, with PLR not correlating to mortality outcomes in this group. WPR correlated with LODS (r=0.37, P< 0.01), and LqSOFA (r=0.35, P=0.05) severity scores. Conclusions: PLR and WPR are promising, low-cost prognostic biomarkers in sepsis and malaria in RCS sites. PLR was associated with sepsis mortality, and WPR was associated with malaria mortality and organ dysfunction. These simple hematologic ratios may improve early risk stratification in RCS, and prospective studies are warranted to validate these biomarkers.
Danso et al. (Sun,) studied this question.