Uncovering heterogeneity in sepsis: a comparative analysis of subphenotypes

Journal article

BackgroundSepsis is a life-threatening condition that requires rapid assessment to reduce mortality. This study investigates the relationship between the Neutrophil-to-Monocyte/Lymphocyte Ratio (NMLR) upon ICU admission and 28-day mortality in sepsis patients.MethodsA retrospective analysis was performed using clinical data from sepsis patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV). Multivariate logistic regression, sensitivity analyses, and Restricted Cubic Spline (RCS) models were employed to explore the relationship between ICU admission NMLR and 28-day mortality. Kaplan–Meier method and inverse probability weighting (IPW) were used to adjust for confounders and estimate survival outcomes. Receiver operating characteristic (ROC) curve evaluating the predictive value of NLMR for 28-day mortality in ICU sepsis patients. Subgroup analyses considered factors like age, sex, race, comorbidities, and disease severity.ResultsIn total, 8,710 patients were included. Increased NMLR was associated with higher 28-day all-cause mortality, confirmed by multiple logistic regression models. In Model 3, after adjusting for confounders, each standard deviation increase in NMLR was associated with a 1.5% increase in 28-day mortality risk. Kaplan–Meier and IPW survival analyses showed higher 28-day all-cause mortality in patients with elevated NMLR levels at ICU admission compared to those with lower levels (p < 0.0001, p = 0.031). RCS models suggested a potential non-linear relationship between NMLR and 28-day mortality. ROC curve for the NMLR model, with an AUC of 0.658 (95% CI: 0.642–0.673). Sensitivity analyses confirmed the association even after excluding patients with myocardial infarction and severe liver disease.ConclusionElevated NMLR at ICU admission is significantly associated with increased 28-day all-cause mortality in sepsis patients, suggesting its potential as an early prognostic indicator for risk assessment and intervention

Authors: van Amstel, RBE; Kennedy, JN; Scicluna, BP; Bos, LDJ; Peters-Sengers, H

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Intensive Care Medicine
• Volume: 49
• Issue: 11
• Pages: 1360-1369
• Publication date: 2023-10-18
• DOI: 10.1007/s00134-023-07239-w
• EISSN: 1432-1238
• ISSN: 0342-4642
• Language: English
• Keywords: Oncology; Subtyping; Critically ill; Biology; Observational study; Concordance; Biomarker; Internal medicine; Sepsis; Cohort study; Cohort; Intensive care medicine; Medicine; Genetics