ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1602016
The V-shaped association between the ratio of neutrophil counts to prognostic nutritional index and 30-, 60-, and 90day mortality in elderly critically ill patients aged 65 and older with sepsis: A retrospective study based on the MIMIC database
Provisionally accepted
- 1The First Affiliated Hospital of Soochow University, Suzhou, China
- 2Ningbo No.2 Hospital, Ningbo, China
- 3Department of Ultrasound, Children's Hospital of Soochow University, Suzhou, China
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Objective: To investigate the association between the ratio of neutrophil counts to prognostic nutritional index (NPNR) and mortality risk in elderly patients with severe sepsis aged 65 and older.Methods: This retrospective study utilized data from the MIMIC-IV (v2.2) database.We selected elderly patients (aged ≥65 years) with sepsis admitted to the ICU for the first time. After excluding patients with hematologic disorders, autoimmune diseases, or active malignancies, 13,176 patients were screened. Among them, 1,179 had complete data for NPNR calculation and were included. The primary endpoint was 30day mortality, with secondary endpoints including 60-day and 90-day in-hospital and ICU mortality. We used Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic spline (RCS) regression models, and comprehensive sensitivity analyses to assess the association between NPNR and mortality risk.Results: NPNR was significantly associated with increased mortality risk. Kaplan-Meier survival curves demonstrated lower survival rates in extreme quartiles (Q1 and Q4) across all time frames (P<0.001). Cox regression showed significant associations for NPNR as a continuous variable and in higher quartiles. After adjustment for confounders including albumin infusion status, the V-shaped association persisted in RCS models (P<0.001). Sensitivity analyses using multiple imputation and subgroup stratification confirmed robustness. The excluded patients (n=11,997) showed comparable baseline severity to the included cohort.NPNR is a significant predictor of mortality in elderly sepsis patients. Its V-shaped association reflects dual risks of immunonutritional depletion and hyperinflammation, highlighting the clinical utility of this composite marker.
Keywords: Neutrophil counts, Prognostic nutritional index, Severe sepsis, elderly patients, mortality risk, V-shaped association
Received: 28 Mar 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Cai, Jin, Lou, Xu, Qi and Li. 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: Jie Li, The First Affiliated Hospital of Soochow University, Suzhou, China
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