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Updated: Jun 22, 2025
A Data-Driven Approach to Quantifying Immune States in Sepsis
Published on: February 7, 2025
Predictive value of the dynamics of absolute lymphocyte counts for 90-day mortality in ICU sepsis patients: a
Daonan Chen1, Kun Zhou2, Rui Tian1
1Shanghai General Hospital, Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Dynamic changes in absolute lymphocyte count (ALC) predict 90-day mortality in sepsis patients. Day 7 ALC is a key predictor, especially for critically ill individuals.
Area of Science:
- Critical Care Medicine
- Hematology
- Epidemiology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Predicting mortality in sepsis patients is crucial for timely intervention and resource allocation.
- The role of dynamic changes in absolute lymphocyte count (ALC) in sepsis outcomes requires further elucidation.
Purpose of the Study:
- To evaluate the clinical predictive value of ALC dynamics for 90-day all-cause mortality in intensive care unit (ICU) sepsis patients.
- To identify specific time points and thresholds of ALC that are most predictive of mortality.
- To assess the utility of ALC as an independent predictor in various sepsis subgroups.
Main Methods:
- Retrospective cohort study utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.
- Inclusion of 17,329 sepsis patients admitted to the ICU, with specific exclusion criteria applied.
- Analysis of ALC trends on days 1, 3, 5, and 7 post-admission, alongside multivariate adjustments and subgroup analyses.
Main Results:
- Lower ALC was observed in non-survivors on days 1, 3, 5, and 7 post-admission (p<0.001).
- ALC on day 7 demonstrated the highest area under the curve (AUC) for predicting 90-day mortality, with a cut-off of 1.0×10^9/L.
- Higher ALC on day 7 was associated with better prognosis, particularly in patients with Sequential Organ Failure Assessment (SOFA) score ≥6 or age ≥60 years.
Conclusions:
- Dynamic changes in ALC are significantly associated with 90-day all-cause mortality in sepsis patients.
- ALC on day 7 serves as a robust independent predictor of 90-day mortality, especially in critically ill or older sepsis patients.
- Incorporating day 7 ALC into prediction models enhances their accuracy for sepsis mortality.
Objectives:
The objective of the study was to assess the clinical predictive value of the dynamics of absolute lymphocyte count (ALC) for 90-day all-cause mortality in sepsis patients in intensive care unit (ICU).
Design:
Retrospective cohort study using big data.
Setting:
This study was conducted using the Medical Information Mart for Intensive Care IV database V.2.0 database.
Primary And Secondary Outcome Measures:
The primary outcome was 90-day all-cause mortality.
Participants:
Patients were included if they were diagnosed with sepsis on the first day of ICU admission. Exclusion criteria were ICU stay under 24 hours; the absence of lymphocyte count on the first day; extremely high lymphocyte count (>10×109/L); history of haematolymphatic tumours, bone marrow or solid organ transplants; survival time under 72 hours and previous ICU admissions. The analysis ultimately included 17 329 sepsis patients.
Results:
The ALC in the non-survivors group was lower on days 1, 3, 5 and 7 after admission (p<0.001). The ALC on day 7 had the highest area under the curve (AUC) value for predicting 90-day mortality. The cut-off value of ALC on day 7 was 1.0×109/L. In the restricted cubic spline plot, after multivariate adjustments, patients with higher lymphocyte counts had a better prognosis. After correction, in the subgroups with Sequential Organ Failure Assessment score ≥6 or age ≥60 years, ALC on day 7 had the lowest HR value (0.79 and 0.81, respectively). On the training and testing set, adding the ALC on day 7 improved all prediction models' AUC and average precision values.
Conclusions:
Dynamic changes of ALC are closely associated with 90-day all-cause mortality in sepsis patients. Furthermore, the ALC on day 7 after admission is a better independent predictor of 90-day mortality in sepsis patients, especially in severely ill or young sepsis patients.
