Could Plateletcrıt, in The Fırst 24 Hours of Lıfe, Be an Early Indıcator of Poor Etıology and Prognosıs in Preterm Infants?

Abstract

Platelet indices such as mean platelet volume (MPV) and platelet numbers (Plt) have been used as predictive indicators in many diseases of preterm infants. However, there is limited data regarding use of plateletcrit (PCT) as an indicator of many detrimental conditions (ie, gestational diabetes, hypertension and infection) and also clinical conditions such as necrotizing enterocolitis (NEC), sepsis and mortality in preterm neonates. Objective: The aim of this retrospective study was to investigate if PCT in the first 24 hour could indicate above mentioned conditions and predict poor prognosis compared to other blood parameters such as Hemoglobin (Hgb), Mean Corpuscular Volume (MCV), Red Blood Cell Distribution Width (RDW), White Blood Cell (WBC), Plt, MPV and Platelet Distribution Width (PDW). Design/Method: All premature babies ≤ 32 weeks and admitted to NICU of Selcuk University between January 2018 to June 2019 were investigated. Their maternal conditions for gestational hypertension (GH), diabetes and infection during pregnancy were analysed to reveal potential relation between antenatal conditions and postnatal markers. Infants were also reviewed according to their clinical prognosis and presence of intrauterine growth restriction (IUGR), sepsis, NEC and mortality. The first blood parameters (Hgb, MCV, RDW, WBC, Plt, MPV, PDW and PCT were recorded and evaluated. Results: Of the 186 infants (GW: 29±1weeks, BW: 1300±100 gr), 92 (49.5%) were girls and 94 (50.5%) were boys. Mean maternal age was 28 ± 1years and 3.8% of these mothers had gestational diabetes, 10.2% hypertension and 9.7% infection. From baby standpoint, 20 infants (10.8%) had IUGR, 50 (26.8%) infants had sepsis, and 18 (9.6%) infants had NEC. Thirty five infants (18.8%) died during hospital course. In term of gender, there was no difference between BW, Mother’s age, although male infants were heavier than females (p<0.05). Hematological parameters were similar between 2 genders (p>0.05). WBC, Plt, RDW parameters were affected from GH. Interestingly MPV was not affected from any antenatal and postnatal conditions, but PCT levels were significantly low in IUGR, sepsis and in mortality group. Although, platelet numbers are closely related with PCT, they were also affected from IUGR. Both sepsis and mortality were found associated with GW and BW. Conclusions: Unlike to many studies showing benefits of MPV as a marker of poor prognosis in preterm babies, our study did not show such a benefit of MPV. On the other hand we found PCT as a good marker for detection of antenatal and postnatal detrimental factors on the newborn babies. We believe that prospective studies are needed to understand value of using PCT in this tiny population.

Keywords

• Plateletcrit
• preterm babies
• marker
• prognosis

References

1. References 1. Chandrashekar V. Plateletcrit as a screening tool for detection of platelet quantitative disorders. J Hematol. 2013;2:22–6. 10.4021/jh70w [CrossRef] [Google Scholar] 2. Adibi P, Faghih Imani E, Talaei M, Ghanei M. Population-based platelet reference values for an Iranian population. Int J Lab Hematol. 2007;29:195–9. 10.1111/j.1751-553X.2006.00843.x [PubMed] [CrossRef] [Google Scholar] 3. Wiwanitkit V. Plateletcrit, mean platelet volume, platelet distribution width: its expected values and correlation with parallel red blood cell parameters. Clin Appl Thromb Hemost. 2004;10:175–8. 10.1177/107602960401000208 [PubMed] [CrossRef] [Google Scholar] 4. Margetic S. Inflammation and haemostasis. Biochem Med (Zagreb). 2012;22:49–62. 10.11613/BM.2012.006 [PMC free article] [PubMed] [CrossRef] [Google Scholar] 5. Zhang S, Cui YL, Diao MY, Chen DC, Lin ZF. Use of platelet indices for determining illness severity and predicting prognosis in critically ill patients. Chin Med J (Engl). 2015;128:2012–8. 10.4103/0366-6999.161346 [PMC free article] [PubMed] [CrossRef] [Google Scholar] 6. Thachil J. Platelets in inflammatory disorders: a pathophysiological and clinical perspective. Semin Thromb Hemost. 2015;41:572–81. 10.1055/s-0035-1556589 [PubMed] [CrossRef] [Google Scholar] 7. Takeyama H, Mizushima T, Iijima H, Shinichiro S, Uemura M, Nishimura J, et al. Platelet activation markers are associated with Crohn’s disease activity in patients with low C-reactive protein. Dig Dis Sci. 2015;60:3418–23. 10.1007/s10620-015-3745-2 [PubMed] [CrossRef] [Google Scholar] 8. Beyazit Y, Sayilir A, Torun S, Suvak B, Yesil Y, Purnak T, et al. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2012;36:162–8. 10.1016/j.clinre.2011.10.003 [PubMed] [CrossRef] [Google Scholar]
2. 9. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010;8:148–56. 10.1111/j.1538-7836.2009.03584.x [PMC free article] [PubMed] [CrossRef] [Google Scholar] 10. Novosad SA, Sapiano MRP, Grigg C, et al. Vital signs: epidemiology of sepsis: prevalence of health care factors and opportunities for prevention. Morb Mortal Wkly Rep. 2016;65(33):864–869. doi: 10.15585/mmwr.mm6533e1. [PubMed] [CrossRef] [Google Scholar] 11. Vincent J-L, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):1303–1310. doi: 10.1001/jama.2009.1754. [PubMed] [CrossRef] [Google Scholar] 12. Mandruzzato G. Intrauterine restriction (IUGR) J Perinat Med. 2008;36:277–281. [PubMed] [Google Scholar] 13. Kafetzis DA, Skevaki C, Costalos C. Neonatal necrotizing enterocolitis: an overview. Curr Opin Infect Dis 2003;16:349–55. 14. Neu J. Necrotizing enterocolitis. World Rev Nutr Diet 2014;110:253– 63. 15. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. Lancet. 1993;341:515–518. [PubMed] [Google Scholar] 16. Povoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2005;11:101–108. [PubMed] [Google Scholar]