Syst Rev. 2025 Nov 12;14(1):222. doi: 10.1186/s13643-025-02979-w.
ABSTRACT
BACKGROUND: Sepsis remains a major global health issue, especially in low- and middle-income countries (LMICs) with limited diagnostic resources. This meta-analysis evaluates platelet index ratios (mean platelet volume-to-platelet count, MPV/PLT; platelet distribution width-to-platelet count, PDW/PLT; and platelet distribution width-to-plateletcrit, PDW/PCT) as cost-effective biomarkers for sepsis diagnosis and prognosis in resource-constrained settings.
METHODS: A systematic search was conducted for studies evaluating platelet parameter ratios in sepsis. Inclusion criteria comprised the following: (1) cohort/case-control designs; (2) non-duplicated datasets; (3) available quantitative data for meta-analysis. Exclusion criteria included reviews, abstracts, letters to the editor, and studies with incomplete data. Synthesis methods employed random-effects models to calculate standardized mean differences (SMD) and diagnostic metrics (sensitivity, specificity, etc.), with heterogeneity assessed via I-squared statistics. Publication bias was evaluated through funnel plots and Egger’s test.
RESULTS: Fourteen studies were included. The results revealed that MPV/PLT ratios were significantly higher in neonatal (SMD = 1.48, P = 0.004) and adult sepsis patients (SMD = 0.35, P < 0.001) than in controls. Survivors had significantly lower MPV/PLT ratios than non-survivors in both children/neonate (SMD = 0.67, P < 0.01) and adult group (SMD = 0.41, P < 0.01), with similar trends observed in longitudinal assessments. PDW/PLT was also lower in pediatric survivors (P = 0.009), while no significant differences were found for MPV/PCT in neonates or PDW/PLT in adults. For diagnosing sepsis, MPV/PLT had a sensitivity of 0.55 and specificity of 0.71 in adults, and 0.58 and 0.87 in neonates. For predicting mortality, neonatal sepsis showed higher sensitivity (89%) and specificity (73%) than adult sepsis (63%, 58%). In LMICs, MPV/PLT was elevated at admission in both age groups but was linked to survival only in neonates.
CONCLUSION: The MPV/PLT ratio shows promise as a cost-effective biomarker for sepsis diagnosis and prognosis, particularly in neonatal patients, with important potential applications in LMICs.
SYSTEMATIC REVIEW REGISTRATION: This study has been registered on the international platform of registered systematic review and meta-analysis protocols (INPLASY) (Registration Number: INPLASY202540096). https://doi.org/10.37766/inplasy2025.4.0096 .
PMID:41225524 | DOI:10.1186/s13643-025-02979-w
