Relationship between effusion and inflamatory markers including platelet count in children with parapneumonic effusion

Abstract

Objective: Although mortality and morbidity due to community-ac-quired pneumonia (CAP) decrease in childhood, parapneumonic effusion (PE) and empyema still emerge as an important problem. There are many studies related to platelet count and mean platelet volüme (MPV) in CAP together with many inflammatory markers. In this study, the need for fibrinolytic therapy (FT) and its relationship with thrombocyte count and MPV in patients with CAP+PE was investigated. Material and Methods: This retrospective study was conducted by including patients who were hospitalized and followed up with the diagnosis of CAP and PE between 2010 and 2017 in Clinic of Pediatric Infec-tion, Gazi University Faculty of Medicine Hospital. Results: Forty-one patients with the diagnosis of CAP+PE were included in the study. 46.3% of the patients were female and 53.7% were male. Median age was 72 months (2.5-192 months), median hospital stay was 14 days (2-26). Fibrinolytic therapy was applied to 19 of the patients (43.9%). Of the patients recieved who received FT, 13 (68.4%) received urokinase, five (26.3%) streptokinase, and one alteplase (5.2%). The hospitalization period of patients who received FT, was significantly longer (p= 0.001), and the leukocyte count and CRP levels on the day of hospitalization were significantly higher than those who did not (p= 0.009, p= 0.001). While there was no difference in CRP and leukocyte values ​on the day of discharge between the patients who received FT and those who did not; on the day of discharge, the platelet value was found to be significantly higher in patients who received FT compared to patients who did not (p= 0.02). In 77.8% of patients who received FT, the highest plate-let value was observed after 10th day of hospitalisation whereas 69.9% of the patients who did not receive FT reached the highest platelet count in the first 10 days (p= 0.006). Conclusion: The significantly higher CRP and white blood cell values in pneumonia and parapneumonic effusion patients who received fibrino-lytic therapy compared to those who did not receive FT may be attributed to the more severe inflammation in these patients. Besides the significant increase in discharge platelet values may indicate that thrombocytosis is a late acute phase reactant. However, it may be important that the platelet count reaches the highest level after the 10th day in patients receiv-ing FT, in terms of the possibility that this treatment may contribute to thrombocytosis.