الفهرس 
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Abstract
Among all measured vital signs, the Blood pressure and GCS can be used as prognostic markers of mortality. Regarding CBC, the Neutrophils count, Platelets counts and RBCs can be used as prognostic markers of mortality in pediatrics admitted to PICU with severe infection. And also the percentage of DROP in WBCs count and platelets counts during PICU stay can be used as prognostic markers of mortality in critically ill children. All the above mentioned markers are readily available, sensitive, prognostic markers that can identify the severe sepsis patients with poorest outcome. Use of the above mentioned markers can identify the pediatric patients with severer sepsis and poorest outcome that need more qualified care to decrease mortality among them. The time required to reach the targeted WBCs and Platelets count must be measured. The quality of life among pediatric patients with sepsis must be measured to achieve good patient satisfaction and alleviate the stress of children and their parents. Randomized controlled trials are needed to confirm our results. The present study is an observational cross section study assessing the role of WBCs and platelets count as a prognostic parameters in pediatric patients with severe infection. The study included 120 pediatric patients. The median age of the whole studied pediatrics (n=120) was 8 months and ranged from 1 to 60 months. The median weight was 7 Kg and ranged from 2 to 30 Kg, 79 (65.8%) were males and 41 (34.2%) were females. Regarding the vital signs of studied participants at baseline, the median of Heart rate was 150 and ranged from 80 to 180 beats/minute, the median of Respiratory rate was 55 and ranged from 20 to 90 cycle/minute, 71 (59.0) were normotensive and 48 (40.0) were hypotensive with only one case was hypertensive (0.8). The median GCS of our studied children was 9 and ranged from 3 to 15. 47 (39%) of children admitted to PICU complained from chest infection mainly pneumonia (38% from total infection), 45 (38%) complained from gastrointestinal problems mainly gastroenteritis (35% from total infection), 24 (20%) with neurological problems mainly encephalitis (15% from total infection) and 4 (3%) had cardiac infection in the form of viral myocarditis (3% from total infection). The CBC parameters among pediatrics admitted to PICU shows that, the median (range) of WBCs count was 14 (4.0 - 49.0), Neutrophils was 64.5 (6.0 - 90.0), Lymphocytes was 24.0 (1.0 - 78.0), Monocytes was 5.0 (0.1 - 16.0), Basophils was 0.3 (0.01 - 2.0), Eosinophil was 0.3 (0.01 - 5.0), Platelets was 301.5 (0.5 - 918.0), MPV was 9.0 (4.0 - 32.0), RBCS was 4.0 (0.6 - 6.0) and Hemoglobin was 10.0 (3.6 - 68.0). As regard the outcome of our study, 48 (40%) were survived and discharged from PICU versus 72 (60%) were died. No statistically significant difference between both studied groups was observed except for the type of infection where died children have higher prevalence of CNS and GIT infection (8 (17%) versus 16 (22%) for CNS infection and 14 (29%) versus 31 (43%) for GIT infection, p=0.032) and another difference in the median WBCs count where survived children have higher WBCs count, it was [18.3 (5.5 - 49.0) versus 12.7 (4.0 - 31.0) p=0.001] respectively. By comparing the same studied variables at the time of discharge or death among survived and died children, we found statistically significant difference between both studied groups for all clinical data (HR, RR and BP), Also the GCS was more better in survived children than dyed ones, it was 14 (3 – 15) versus 7 (3 – 15) p=0.000 respectively. Also as regard the laboratory data, there was statistically significant difference between both studied groups for most CBC parameters (WBCs, Neutrophils, Lymphocytes, Platelets and RBCs), p<0.05. Which mean that all clinical and laboratory data were improved in survived children. Blood pressure and GCS can be used as a prognostic marker of mortality. For Blood pressure, children with abnormal BP are 14 times more likely to die than normotensive children (p=0.005) and for GCS, children with abnormal GCS are about 62 times more likely to die than children with normal GCS (p=0.000). The predictive ability of Blood pressure and GCS were measured by using the ROC curves. The areas under the ROC curves for both were 86.1% and 90.3%, respectively. GCS was observed to be a significantly better predictor of mortality in pediatrics admitted to PICU with severe infection with higher AUC than the Blood pressure (p=0.000). The Neutrophils count, Platelets counts and RBCs can be used as prognostic markers of mortality in pediatrics admitted to PICU with severe infection. For Neutrophils count, children have the same probability of being died (p=0.002, 95% CI 1.022 – 1.099), the same for Platelets counts (p=0.003, 95% CI 0.992 – 0.998) but for RBCs, for every one unit increase in RBCs, children are 2.5 time more likely to survive (p=0.000, 95% CI 1.190 – 5.051). Also the predictive ability of them was analyzed by using the ROC curves. The areas under the ROC curves for them were 12.2%, 79.6% and 63.8%, respectively. Platelets count was observed to be a significantly better predictor of mortality in pediatrics admitted to PICU with severe infection with higher AUC (p=0.000). There were statistically significant differences in the percent DROP in WBCs count and Platelets count between survivors and non-survivors at both time points studied (at day 5 and at discharge). As regard WBCs count, it was 27.17% versus 6.94% p=0.028 and 41.96% versus 2.21% p=0.000 at day 5 and at discharge respectively which mean that the percentage of DROP was much higher in survivors than non-survivors children. Meanwhile, the Platelets count was 2.76% versus 17.55% p=0.013 and 8.71% versus 48.17% p=0.000 at day 5 and at discharge respectively which mean that the percentage of DROP was much higher in non-survivors than survivors children. The predictive ability of both was analyzed by using the ROC curve. For percent DROP in WBCs count the Area under curve (AUC) at day 5 was (0.615) and at discharge was (0.754). While for the percent DROP in platelets count the Area under curve (AUC) at day 5 was (0.631) and at discharge was (0.713). The percent DROP at discharge for both were observed to be a significantly better predictors of mortality in pediatrics admitted to PICU with severe infection with higher AUC than at day 5 (p=0.000). As AUC for DROP in WBCs count and platelets count at discharge for criteria > 17.6% and > 26.5% had highest sensitivity and specificity. Rounded figure of DROP ≥18% for WBCs and ≥27% for platelets as independent risk factors for mortality were studied with multivariate analysis by using forward stepwise method of binary logistic regression. For DROP in WBCs count, children who have DROP in WBCs count ≥ 18% are about 11 times more likely to survive (p=0.000, 95% CI 4.048 – 30.303), meanwhile for DROP in Platelets counts, children who have DROP in platelets count ≥ 27% are about 4 times more likely to die (p=0.001, 95% CI 1.778 – 10.903), which mean that thrombocytopenic children had significantly higher mortality. The present results and other existing data show that WBCs and Platelets counts can be used as prognostic markers in pediatric patients with sepsis. Larger, prospective, randomized trials are needed to confirm the data for better treatment of pediatric patients, better PICU outcomes and for better quality of life. There is a vital need for the development of individualized interventions programs tailored to the physical and psychological well-being of pediatric patients in Assuit Children Hospital.