Can inflammatory indices predict mortality in patients with sepsis?

Objective:The aim of this study was to evaluate the predictive value of inflammatory indices [Multi-Inflammatory Index (MII): (Neutrophil/Lymphocyte) X CRP, CRP Albumin Ratio (CAO): CRP/Albumin and Systemic Immune Inflammatory Index (SII): Neutrophil Count X (Platelet/Lymphocyte)] for mortality in patients with sepsis hospitalized in the intensive care unit. In this way, we aim to identify critically ill patients and manage their follow-up and treatment more carefully and effectively by starting early treatment. Materials and Methods:In this study, the data of 120 patients diagnosed with sepsis hospitalized in the Internal Medicine Intensive Care Unit of Dicle University Faculty of Medicine between 08.08.2013-08.08.2023 were obtained from the hospital information management system and analyzed retrospectively. Epidemiologic characteristics of the patients, comorbidities, hemogram results, albumin and CRP levels, the agent grown in the first culture, possible focus of infection, duration of intensive care unit stay, survival and SOFA (Sequential Organ Failure Assessment ) score according to the 2021 sepsis guidelines were evaluated. However, patients with sepsis, diabetic ketoacidosis, nonketotic hyperosmolar hyperglycemic state, congestive heart failure, acute pulmonary edema, intracranial hemorrhage, uremic coma, cirrhosis, nephrotic syndrome, hematologic disease, terminal malignancy were excluded. Results:In our study, 120 patients were analyzed. According to the results obtained in our study, the mean age of all patients was 63.98 ± 20.33 years (17 - 96). It was found that 39.2% of the patients were male and 60.8% were female. Among the comorbidities found in the patients, hypertension and diabetes mellitus ranked first with 31.7% each. In the culture evaluation of the patients, 46.2% of our patients had no growth in the first culture. The most common focus of infection in our study was lung with a rate of 40%. SOFA score was found to be statistically significantly higher in patients who died compared to patients who survived (Z=-4.172; p<0.05). An increase of 1 unit in SOFA value increased the mortality risk by 1.621 times and an increase of 1 unit in CAO value increased the mortality risk by 4.735 times. There was no statistically significant difference between neutrophil values and mortality according to mortality status. Platelet values were found to be statistically significantly lower in patients who died compared to patients who survived (Z=-3,167; p<0,05). Lymphocyte values were found to be statistically significantly lower in patients who died compared to patients who survived (Z=-2,560; p<0,05). MII values were statistically significantly higher in patients who died compared to patients who survived. (Z=-2.401; p<0.05). There was no statistically significant difference between SII values and mortality according to the mortality status of the patients included in our study. CRP values were found to be statistically significantly higher in patients who died compared to patients who survived (Z=-3.074; p<0.05). Albumin values were found to be statistically significantly lower in patients who died compared to patients who survived (Z=-2,186; p<0,05). CAO values were found to be statistically significantly higher in patients who died compared to patients who survived (Z=-3,408; p<0,05). The mean duration of intensive care unit stay of the patients in our study was 35.03 ± 70.11 days. The 15-day OS rate was 41.6%, one-month OS rate was 27.9%, six-month OS rate was 10.1% and 12-month OS rate was 0%. Conclusion: MII and CAO values can be calculated by using the laboratory results during intensive care admission. These inflammatory indexes are practical parameters that can be used to predict mortality in all patients with suspected sepsis, which can be calculated both quickly and easily. Since sepsis is an important health problem in which early diagnosis and treatment are very important, these parameters can be used to have an idea about mortality in the early period, so that earlier treatment can be started in critically ill patients and better patient management can be done.The use of these inflammatory indices together with other scoring systems will provide a better idea. Keywords: Sepsis,SOFA,CAO,MII,SII