ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Clinical Infectious Diseases
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1603104
This article is part of the Research TopicMolecular mechanisms and clinical studies of multi-organ dysfunction in sepsis associated with pathogenic microbial infectionView all 19 articles
The J-shaped association between the ratio of neutrophil counts to prognostic nutritional index and mortality in ICU patients with sepsis: a retrospective study based on the MIMIC database
Provisionally accepted
Jiaqi Lou1
Hong Kong2Ziyi Xiang3Xiaoyu Zhu4
Shengyong Cui1,5Jiliang Li1Guoying Jin1
Neng Huang1
Xin Le1
Youfen Fan1*Sida Xu1*- 1Burn Department, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China
- 2Ningbo College of Health Sciences, Ningbo, Zhejiang Province, China
- 3Institute of Physiology I, Faculty of Medicine, University of Bonn, Bonn, Nordrhein-Westfalen, Germany
- 4Department of Health Science Center, Ningbo University, Ningbo, Zhejiang, China
- 5Ningbo Second Hospital, Ningbo, China
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The ICU faces persistent challenges with sepsis, marked by systemic inflammation and metabolic disruptions, often leading to poor outcomes. Despite advances, reliable biomarkers for predicting sepsis outcomes are needed. This study introduces a novel indicator combining neutrophil count and prognostic nutritional index (PNI) to improve predictive accuracy by addressing both inflammatory and nutritional-immune aspects.We conducted a retrospective cohort study analyzing data from the MIMIC-IV database, focusing on adults diagnosed with sepsis per Sepsis 3.0 criteria. We excluded those younger than 18, with ICU stays under 48 hours, multiple ICU admissions, or incomplete data. Participants' neutrophil counts/PNI ratios were calculated and correlated with 30, 60, and 90-day hospital and ICU mortality, utilising Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic spline (RCS) models and subgroup analysis.We included 2,116 patients from 22,517 eligible cases. Survival analysis demonstrated lower survival probabilities for higher neutrophil counts/PNI ratios across all observed time windows. Cox regression models revealed a significant association between higher neutrophil counts/PNI ratios and increased short-to medium-term mortality. The restricted cubic spline regression models illustrated a Jshaped relationship between neutrophil counts/PNI and mortality.The neutrophil counts/PNI ratio is a promising prognostic biomarker for sepsis-related outcomes in ICU settings, offering improved risk stratification and potentially guiding therapeutic interventions. Further research is warranted to validate these findings across diverse populations.
Keywords: Youfen Fan, Ningbo No. 2 Hospital, No. 41 Northwest Street, Intensive care unit, Mimic, Mortality, Sepsis, Neutrophil, Prognostic nutritional index
Received: 31 Mar 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Lou, Kong, Xiang, Zhu, Cui, Li, Jin, Huang, Le, Fan and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Youfen Fan, Burn Department, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China
Sida Xu, Burn Department, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China
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