الفهرس 
Definition of sepsis
Admission to ICUOnly 14 pages are availabe for public view
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Abstract
Sepsis is a rapidly progressive, life-threatening disease. Accurate and expeditious assessment of sepsis is important for early administration of antibiotics and removal of the source of infection. Although most patients with sepsis receive intensive management, such as early goal directed therapy (EGDT), in an emergency department (ED), the mortality rate of sepsis has been reported to be greater than 20% to 30%. Many clinicians have studied the usefulness of blood biomarkers such as C-reactive protein, procalcitonin, and lactate for early assessment of sepsis and for prognostication, in order to initiate timeous treatment and to prevent rapid progression to multi-organ failure. Several studies mentioned the advantages of the precursor molecule of calcitonin, namely procalcitonin as a biomarker for sepsis. Studies have reported that platelets and lymphocytes play critical roles in the inflammatory process. Therefore, the platelet-to-lymphocyte ratio (PLR) a novel inflammatory factor has received research attention, as it may act as an indicator of inflammation, in a wide spectrum of diseases, such as myocardial infarction, acute kidney injury (AKI). Based on the findings of previous studies, it is reasonable to speculate the presence of a potential relationship between PLR and mortality for sepsis. The aim of this study was to compare effectiveness of platelets to lymphocytes ratio (PLR) with procalcitonin as a predictor of sepsis outcome. Prediction of 28 days mortality was the primary outcome while length of ICU stay (days), length of hospital stay and sequential organ failure score (SOFA) score were secondary outcomes.This prospective cross-sectional study included 54 septic patients aged 21-65 years with ICU stay more than 24 hrs. Blood samples were used for evaluation of whole blood count and procalcitonin serum levels at diagnosis, 3 ,7 and 14 days of sepsis. Summary of results • Age was significantly increased in non-survivors group compared to the survivors group but BMI and sex showed no statically significant difference between two groups. • SOFA score was significantly increase in non-survivors group compared to survivors group and there were increase in ICU stay and hospital stay in survivors group compared to non survivors group. • Cause of infection between two groups showed no significant difference. • The PLT and lymphocytes count in non-survived patients showed statistically significant decrease at different time intervals. • Delta change of PLT and lymphocytes showed significant increase in survivors group compared to non survivors group which show significant decrease in non survivors group. • There was statistically significant increase in platelets to lymphocytes ratio in non survivors group compared to survivors group and delta change showed significant decrease in survivors group compared to non survivors group. • There was statistically significant increase in procalcitonin value in non survivors group compared to survivors group and delta change showed significant decrease in survivors group compared to non survivors group. • The ROC curve analysis showed that Platelet to lymphocytes ratio atcut-off value >228.89 can predict mortality with sensitivity 86.36 %, specificity 87.50 %, PPV 82.6 % and NPV 90.3% with area under the curve 0.945 and (95% C.I: 0.890 – 0.999) with P value<0.001, Procalcitonin at cut-off value >9.2 ng/mL with sensitivity 95.45%, specificity 90.6%, PPV 88.0% and NPV 100% with area under the curve 0.977 and (95% C.I: 0.946 – 1.0) with P value<0.001.and SOFA score at cut-off value >7 can predict mortality with sensitivity 100%, specificity 84.37%, PPV 81.5% and NPV 100% with area under the curve 0.982and (95% C.I: 0.957 – 1.007) with P value<0.001. • In our results SOFA score was found to be most effective in prediction of mortality with area under the curve 0.982 second most effective was procalcitonin with area under the curve 0.977 and Platelet to lymphocytes ratio was third with area under the curve 0.945. • The ROC curve analysis showed that delta change of Platelet to lymphocytes ratio at day 7 cut-off value is > 68 can predict mortality with sensitivity 80.0 %, specificity 90.62 %, PPV 72.7 % and NPV 93.5 % with area under the curve 0.841 and (95% C.I: 0.642 – 1.039) with P value<0.001 and delta change of Procalcitonin at day 7 cut-off value is >3.6 ng/mL can predict mortality with sensitivity 90.0 %, specificity 96.87%, PPV 90.0 % and NPV 96.9 % with area under the curve 0.978 and (95% C.I: 0.934 – 1.022) with P value<0.001. • There is significant correlation between PLR and ICU stay and hospital stay in survivors patients. higher PLR is associated with longer ICU stay and hospital stay at diagnosis and significant correlation between delta change in PLR and ICU stay and hospital stay in survivors patients. more delta change in PLR is associated with shorter ICU and hospital stay at day 3, 7 and day 14. • Our results showed that there is significant correlation between PLR and SOFA score between the two groups in prediction of mortality (Pvalue<0.001), but no significant correlation between PLR and procalcitonin in prediction of mortality in non survivors group. • There is a significant correlation between delta change in PLR and delta change of procalcitonin at day 7.