Background and Aims
Bacteremia/sepsis are leading causes of death in children worldwide. Early diagnostic markers to distinguish bacterial from viral infections are still missing. 
Aim: To investigate diagnostic value of NLR (neutrophil-lymphocyte ratio),   MPV (mean platelet volume) and Platelet to MPV ratio (PLT/MPV) to distinguish severe bacterial from viral infection in children.

Method
Children (n=115) presented with SIRS to emergency room (ER) were retrospectively enrolled and divided into 2 groups: (A) sepsis/bacteremia (n=68) and (B) viral infection (n=47). For all children blood was drawn, Complete blood count and CRP were assessed. NLR, PLR and PLT/MPV were calculated. Data analysis was performed with IBM SPSS Statistics 21.0. P value <0.05 was considered significant. 

Results
Group A showed significantly higher WBC, neutrophil count  and CRP, and a relevant increase in platelet count and NLR.  
NLR, MPV and PLT/MPV were significantly lower in infants of group B when they arrived at ER late (>12hrs) (see Table 1).

Table 1.			
Marker	Group A	Group B	p value
WBC ( x109/l)	17.94 ± 10.04	10.42 ± 4.21	< 0.001
Neutrophils ( x109/l)	10.93 ± 8.03	5.08 ± 3.42	< 0.001
Platelets (x109/l)	370.15 ± 134.65 	288.91 ± 107.14	0.001
CRP (mg/l)	88.92 ± 83.05 	13.95 ± 16.06	< 0.001
NLR	2.69 ± 2.03	1.83 ± 1.70	0.006
PLT/NLR 43.86 ± 11.58  29.80 ± 8.69   <0.001
infants ≤ 1yr			
NLR	1.90 ± 1.25	1.16 ± 1.06	0.025
MPV (fl)	9.44 ± 0.85	8.94 ± 0.95	0.046
PLT/NLR 42.70 ± 8.57  31.01 ± 8.21   0.008
Conclusion
-WBC and CRP showed to be the most reliable biomarkers to
determine bacterial infection and differentiate from viral infections, at
any time of arrival
-PLT, NLR and PLT/MPV could be considered as a bacterial infection
marker in children who arrived to ED early
-PLT/MPV is one of the most sensitive early bacteremia/sepsis
markers in infants

THE EMERGENCY DIAGNOSTIC MARKERS IN PEDIATRIC PATIENTS WITH SUSPECTED SEPSIS/BACTEREMIA