Work

Age and the association between admission platelet count and in-hospital mortality in critically ill children

Year: 2026

Type: article

Abstract: Objective To investigate whether the prognostic weight of admission coagulation markers for in-hospital mortality varies with age in critically ill children. Methods We retrospectively analyzed children admitted to the intensive care unit (ICU) in the Pediatric Intensive Care database, with in-hospital mortality as the primary outcome. Logistic regression was used to examine the interactions between age and six coagulation markers—platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, and D-dimer—with stepwise adjustment for sex, ICU, admission lactate, vasoactive agent use, and diagnostic category. Sensitivity analyses included adjustment with a modified pediatric Sequential Organ Failure Assessment (pSOFA) score, multiple imputation, exclusion of severe thrombocytopenia, and bootstrapping. Results A total of 11,508 children were included, with 693 in-hospital deaths (6.0%). Among the six markers, only platelet count had a statistically significant age interaction after adjustment (odds ratio [OR]=0.957 per year, P=0.004); the INR interaction was not statistically significant after adjustment (P=0.88), and no statistically significant age interaction was detected for PT, APTT, fibrinogen, or D-dimer. D-dimer had the highest observed overall area under the receiver operating characteristic curve (0.70). In age-stratified adjusted analyses, the OR for death per 50×10⁹/L decrease in platelet count was generally higher in older age groups, ranging from 1.13 in neonates to 1.51 in adolescents, and the interaction remained significant after modified pSOFA adjustment, multiple imputation, and all exclusion analyses. Compared with conventional adult cutoffs, the Pediatric Organ Dysfunction Information Update Mandate criteria classified fewer children as abnormal and generally identified subgroups with higher unadjusted odds of death in this cohort. Conclusion In this cohort, the association between platelet count at ICU admission and in-hospital mortality varied with age, supporting further evaluation and external validation of age-specific platelet weighting in pediatric coagulopathy scoring systems.

Source: Scientific Reports

DOI: 10.1038/s41598-026-75772-x