Development and validation of a sepsis-specific systemic inflammation classification system for mortality prediction

Area of Science:

• Critical Care Medicine
• Biochemistry
• Clinical Nutrition

Background:

• The prognostic implications of nutrition and systemic inflammation in sepsis are not fully understood.
• Existing nutrition/inflammation-based indices have unclear predictive value for sepsis mortality.

Purpose of the Study:

• To evaluate 18 nutrition/inflammation indices for predicting sepsis patient mortality.
• To develop and validate a Sepsis-Specific Systemic Inflammation Classification (SSIC) system.

Main Methods:

• Analysis of 11,577 sepsis patients from the MIMIC-IV 3.0 database.
• Calculation of 18 nutrition/inflammation indices from biochemical and anthropometric data.
• Development and validation of the SSIC system using neutrophil-to-lymphocyte ratio (NLR) and glucose-to-lymphocyte ratio (GLR).

Main Results:

• Seven of 18 indices predicted in-hospital and in-ICU mortality, but with low discrimination.
• Neutrophil-to-lymphocyte ratio (NLR) and glucose-to-lymphocyte ratio (GLR) showed the best predictive performance.
• The SSIC system effectively stratified sepsis patients into low, moderate, and high mortality risk categories, enhancing existing scoring systems.

Conclusions:

• Nutrition/inflammation indices, particularly NLR and GLR, have predictive value for sepsis mortality.
• The validated SSIC system offers improved mortality risk stratification for sepsis patients.
• The SSIC system warrants further evaluation alongside established clinical severity scores.