Dynamic risk stratification and treatment optimization in sepsis: the role of NLPR

作者：Qiqi Chen, Ming Zhang, Yuxin Xia, Ya Deng, Yanna Yang, Lili Dai, Hongxia Niu · 发表于：Frontiers in Pharmacology · 年份：2025 · DOI：10.3389/fphar.2025.1572677 · 被引用次数：10 · 研究领域：Inflammatory Biomarkers in Disease Prognosis、Sepsis Diagnosis and Treatment、Inflammation biomarkers and pathways

Background: Sepsis, characterized by immune dysregulation, inflammatory cascades, and coagulation dysfunction, remains a global health challenge with high mortality, particularly in patients with multiple organ dysfunction syndrome (MODS). Existing prognostic tools, such as SOFA and APACHE II scores, are limited by complexity and lack of real-time monitoring, necessitating simple and reliable biomarkers for risk stratification and individualized management. Objective: This study aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte-to-platelet ratio (NLPR) for mortality in sepsis patients and explore its potential utility in dynamic risk stratification and treatment optimization. Methods: We conducted a retrospective cohort study using the MIMIC-IV database (v3.1), including adult sepsis patients meeting Sepsis-3.0 criteria. NLPR was calculated based on neutrophil, lymphocyte, and platelet counts within 24 h of admission. Patients were stratified into quartiles (Q1-Q4) based on NLPR values. Kaplan-Meier survival analysis, Cox regression models, and restricted cubic spline (RCS) analysis were performed to assess NLPR's association with 28-day, 90-day, and 365-day mortality. Subgroup analyses examined NLPR's performance in diverse clinical populations. Results: NLPR was a strong and independent predictor of mortality at all time points. Patients in the highest NLPR quartile (Q4) had significantly higher 28-day (28.22% vs. 12.64%), 90-day (36.82% vs. 18.06%), an...