AUTHOR=Li Dongkai , Hou Jiatong , Shi Zhan , Li Xiao , Zhang Jiahui , Zhao Guoyu , Lei Xianli , Xie Yawen , Wang Yuefu , Wang Hao , Chang Zhigang , Cui Na 

TITLE=Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study

JOURNAL=Frontiers in Immunology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1624655

DOI=10.3389/fimmu.2025.1624655

ISSN=1664-3224

ABSTRACT=BackgroundFrailty is associated with poor outcomes in elderly sepsis patients. This study investigated the relationship between Frailty Index-laboratory (FI-lab) and lymphocyte patterns in predicting 28-day mortality among elderly sepsis patients.MethodsWe conducted a multicenter prospective observational study in four tertiary hospitals in Beijing, China. FI-lab was calculated using 24 laboratory parameters. Peripheral blood lymphocyte subsets were measured at ICU admission. Lymphocyte count trajectories were classified into four phenotypes based on patterns during the first 72 hours. The primary outcome was 28-day mortality.ResultsAmong 1,197 patients (mean age 74.6 ± 7.4 years), those with high FI-lab risk showed higher mortality (22.2%) than intermediate (12.0%) and low-risk groups (6.1%). Age-stratified analysis demonstrated consistent FI-lab prognostic value in both 65–79 years (OR 2.18) and ≥80 years (OR 2.47) groups. All lymphocyte subset counts were lower in non-survivors, particularly natural killer cells. In multivariable analysis, high FI-lab risk (OR 2.31), APACHE-II scores (OR 1.08), heart rate (OR 1.01), NK cell count (OR 0.994), and pulmonary infection (OR 1.96) independently predicted 28-day mortality. A combined model incorporating these variables showed superior discriminative ability (AUC=0.788) with excellent internal validation (optimism-corrected AUC=0.775).ConclusionsFI-lab independently predicts mortality in elderly sepsis patients and correlates with lymphocyte abnormalities. When comprehensive immune assessment is unavailable, lymphocyte trajectory patterns offer a practical approach for risk stratification.