Huang Zhishan, Cui Ying, Zhang Chen, Yu Huijie, Chen Lina, Wang Xingxing, Zhou Jiancang, Lan Peng
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Critical Care Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
Front Cell Infect Microbiol. 2025 Jul 31;15:1593589. doi: 10.3389/fcimb.2025.1593589. eCollection 2025.
Sepsis, characterized by organ dysfunction due to a dysregulated immune response, is diagnosed using the Sequential Organ Failure Assessment (SOFA) score, which currently lacks immune function markers. The objective of this research is to enhance the predictive precision of SOFA for sepsis by integrating lymphocyte count as an indicator of immune system functionality.
This retrospective study was based on the MIMIC-IV database. The absolute lymphocyte count (ALC) was assessed as a predictive biomarker through multivariate analysis utilizing the Cox proportional-hazards model and was integrated into a modified SOFA score (ALC-SOFA). Associations between ALC-SOFA score and mortality were assessed using Kaplan-Meier survival analysis. Predictive performance was evaluated by comparing the area under the receiver operating characteristic (AUROC) curve for ALC-SOFA and the original SOFA score. The primary endpoint was the mortality rate at 28 days, with additional secondary endpoints including the mortality rates at 7 and 90 days.
10,709 patients with sepsis were included in this study. ALC was significantly lower in nonsurvivors than in survivors (0.90 ± 0.62×10/L vs. 1.12 ± 0.69×10/L, P<0.001). Patients with lower absolute lymphocyte counts (ALC) exhibited a significantly higher risk of 28-day mortality (HR = 0.62, P<0.001). Survival analysis revealed higher mortality rates with increasing ALC-SOFA scores. The ALC-SOFA score demonstrated improved prognostic performance for 28-day mortality (AUROC = 0.680 vs. 0.664, P<0.001) and 90-day mortality (AUROC = 0.666 vs. 0.647, P<0.001) compared to the original SOFA score.
Incorporating ALC into the SOFA score significantly improves its ability to predict sepsis-related outcomes. The ALC-SOFA score provides a novel tool for prognostic assessment, highlighting the critical role of immune function in sepsis management.
脓毒症的特征是免疫反应失调导致器官功能障碍，目前使用序贯器官衰竭评估（SOFA）评分进行诊断，该评分目前缺乏免疫功能标志物。本研究的目的是通过将淋巴细胞计数作为免疫系统功能的指标纳入其中，提高SOFA对脓毒症的预测准确性。
本回顾性研究基于MIMIC-IV数据库。通过使用Cox比例风险模型的多变量分析，将绝对淋巴细胞计数（ALC）评估为预测生物标志物，并将其纳入改良的SOFA评分（ALC-SOFA）。使用Kaplan-Meier生存分析评估ALC-SOFA评分与死亡率之间的关联。通过比较ALC-SOFA和原始SOFA评分的受试者操作特征（AUROC）曲线下面积来评估预测性能。主要终点是28天的死亡率，其他次要终点包括7天和90天的死亡率。
本研究纳入了10709例脓毒症患者。非幸存者的ALC显著低于幸存者（0.90±0.62×10⁹/L对1.12±0.69×10⁹/L，P<0.001）。绝对淋巴细胞计数（ALC）较低的患者28天死亡率风险显著更高（HR = 0.62，P<0.001）。生存分析显示，随着ALC-SOFA评分增加，死亡率更高。与原始SOFA评分相比，ALC-SOFA评分在预测28天死亡率（AUROC = 0.680对0.664，P<0.001）和90天死亡率（AUROC = 0.666对0.647，P<0.001）方面表现出更好的预后性能。
将ALC纳入SOFA评分可显著提高其预测脓毒症相关结局的能力。ALC-SOFA评分为预后评估提供了一种新工具，突出了免疫功能在脓毒症管理中的关键作用。
