Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study
BackgroundFrailty is associated with poor outcomes in elderly sepsis patients. This study investigated the relationship between Frailty Index-laboratory (FI-lab) and lymphocyte patterns in predicting 28-day mortality among elderly sepsis patients.MethodsWe conducted a multicenter prospective observa...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1624655/full |
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| author | Dongkai Li Jiatong Hou Zhan Shi Xiao Li Jiahui Zhang Guoyu Zhao Xianli Lei Yawen Xie Yuefu Wang Hao Wang Zhigang Chang Na Cui |
| author_facet | Dongkai Li Jiatong Hou Zhan Shi Xiao Li Jiahui Zhang Guoyu Zhao Xianli Lei Yawen Xie Yuefu Wang Hao Wang Zhigang Chang Na Cui |
| author_sort | Dongkai Li |
| collection | DOAJ |
| description | BackgroundFrailty is associated with poor outcomes in elderly sepsis patients. This study investigated the relationship between Frailty Index-laboratory (FI-lab) and lymphocyte patterns in predicting 28-day mortality among elderly sepsis patients.MethodsWe conducted a multicenter prospective observational study in four tertiary hospitals in Beijing, China. FI-lab was calculated using 24 laboratory parameters. Peripheral blood lymphocyte subsets were measured at ICU admission. Lymphocyte count trajectories were classified into four phenotypes based on patterns during the first 72 hours. The primary outcome was 28-day mortality.ResultsAmong 1,197 patients (mean age 74.6 ± 7.4 years), those with high FI-lab risk showed higher mortality (22.2%) than intermediate (12.0%) and low-risk groups (6.1%). Age-stratified analysis demonstrated consistent FI-lab prognostic value in both 65–79 years (OR 2.18) and ≥80 years (OR 2.47) groups. All lymphocyte subset counts were lower in non-survivors, particularly natural killer cells. In multivariable analysis, high FI-lab risk (OR 2.31), APACHE-II scores (OR 1.08), heart rate (OR 1.01), NK cell count (OR 0.994), and pulmonary infection (OR 1.96) independently predicted 28-day mortality. A combined model incorporating these variables showed superior discriminative ability (AUC=0.788) with excellent internal validation (optimism-corrected AUC=0.775).ConclusionsFI-lab independently predicts mortality in elderly sepsis patients and correlates with lymphocyte abnormalities. When comprehensive immune assessment is unavailable, lymphocyte trajectory patterns offer a practical approach for risk stratification. |
| format | Article |
| id | doaj-art-47fdbfa1ff33422881ae73d2b8cf1928 |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-47fdbfa1ff33422881ae73d2b8cf19282025-08-20T03:50:49ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-07-011610.3389/fimmu.2025.16246551624655Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort studyDongkai Li0Jiatong Hou1Zhan Shi2Xiao Li3Jiahui Zhang4Guoyu Zhao5Xianli Lei6Yawen Xie7Yuefu Wang8Hao Wang9Zhigang Chang10Na Cui11Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, ChinaSurgical Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Jishuitan Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, ChinaSurgical Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Jishuitan Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaBackgroundFrailty is associated with poor outcomes in elderly sepsis patients. This study investigated the relationship between Frailty Index-laboratory (FI-lab) and lymphocyte patterns in predicting 28-day mortality among elderly sepsis patients.MethodsWe conducted a multicenter prospective observational study in four tertiary hospitals in Beijing, China. FI-lab was calculated using 24 laboratory parameters. Peripheral blood lymphocyte subsets were measured at ICU admission. Lymphocyte count trajectories were classified into four phenotypes based on patterns during the first 72 hours. The primary outcome was 28-day mortality.ResultsAmong 1,197 patients (mean age 74.6 ± 7.4 years), those with high FI-lab risk showed higher mortality (22.2%) than intermediate (12.0%) and low-risk groups (6.1%). Age-stratified analysis demonstrated consistent FI-lab prognostic value in both 65–79 years (OR 2.18) and ≥80 years (OR 2.47) groups. All lymphocyte subset counts were lower in non-survivors, particularly natural killer cells. In multivariable analysis, high FI-lab risk (OR 2.31), APACHE-II scores (OR 1.08), heart rate (OR 1.01), NK cell count (OR 0.994), and pulmonary infection (OR 1.96) independently predicted 28-day mortality. A combined model incorporating these variables showed superior discriminative ability (AUC=0.788) with excellent internal validation (optimism-corrected AUC=0.775).ConclusionsFI-lab independently predicts mortality in elderly sepsis patients and correlates with lymphocyte abnormalities. When comprehensive immune assessment is unavailable, lymphocyte trajectory patterns offer a practical approach for risk stratification.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1624655/fullfrailtysepsiselderlynatural killer cellslymphocytes |
| spellingShingle | Dongkai Li Jiatong Hou Zhan Shi Xiao Li Jiahui Zhang Guoyu Zhao Xianli Lei Yawen Xie Yuefu Wang Hao Wang Zhigang Chang Na Cui Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study Frontiers in Immunology frailty sepsis elderly natural killer cells lymphocytes |
| title | Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study |
| title_full | Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study |
| title_fullStr | Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study |
| title_full_unstemmed | Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study |
| title_short | Frailty Index-laboratory and lymphocyte subset patterns in predicting 28-day mortality among elderly sepsis patients: a multicenter observational cohort study |
| title_sort | frailty index laboratory and lymphocyte subset patterns in predicting 28 day mortality among elderly sepsis patients a multicenter observational cohort study |
| topic | frailty sepsis elderly natural killer cells lymphocytes |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1624655/full |
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