Hematological Alterations and their Prognostic Significance in Critically ill Children Admitted to the PICU

Abstract

ABSTRACT Objective: Hematological parameters such as complete blood count, including red cell distribution width and prothrombin time, activated partial thromboplastin time, and international normalized ratio (INR) are the earliest markers of critical illness. This study was undertaken to evaluate their significance in prognosticating critically ill children admitted to the pediatric intensive care unit (PICU). Methodology: This was a cross-sectional and observational study on 125 critically ill children aged 1 month to 12 years and admitted to the PICU of a tertiary care hospital, conducted from February 2019 to July 2020. Hematological alterations along with clinical profile, Pediatric Risk of Mortality III (PRISM III), and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were analyzed, and prognosis was defined by invasive ventilation requirement, duration of PICU stay, and death. Result: Among the 125 critically ill children, 35.2% were infants. The most common cause of PICU admission was infections (29.6%) followed by the central nervous system (20.8%) and respiratory system (20.8%). Around one-third of the patients required invasive ventilation and about half of the patients required inotropic support in our cohort. Sixty-four percent of critically ill children were found to be anemic at the time of PICU admission. Approximately 50% had leukocytosis and only 6% presented with leukopenia. Thrombocytopenia was present in 24.8%, and 20.8% had thrombocytosis on admission. Fourteen point four percent had deranged INR values. Conclusion: Critically ill children with low hemoglobin (Hb) levels, low white blood cell (WBC) count, high red cell distribution width (RDW) values, and deranged INR required invasive ventilation during PICU stay. Both leukocytosis and leukopenia along with low Hb were associated with prolonged PICU stay and death. No such association was found with either thrombocytopenia or thrombocytosis.