The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury
Abstract Background Sepsis-associated acute kidney injury (SA-AKI) significantly impacts global health. Early identification of SA-AKI patients at inflammatory and immune risk, followed by timely interventions, is critical for improving outcomes. The pan-immune-inflammation value (PIV) reflects syst...
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2025-04-01
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| author | Yidan Zhou Jingjing Hu |
| author_facet | Yidan Zhou Jingjing Hu |
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| description | Abstract Background Sepsis-associated acute kidney injury (SA-AKI) significantly impacts global health. Early identification of SA-AKI patients at inflammatory and immune risk, followed by timely interventions, is critical for improving outcomes. The pan-immune-inflammation value (PIV) reflects systemic inflammation and immune status. However, its prognostic value in SA-AKI remains unexplored. Methods This retrospective cohort study analyzed SA-AKI patients in the MIMIC-IV database. Cox regression assessed the association between PIV and mortality, while restricted cubic spline (RCS) regression explored the relationship between PIV and 30-day and 365-day mortality. Results A total of 2,473 SA-AKI patients in our study were categorized into PIV quartiles: T1 (≤ 214), T2 (214–679), T3 (679–2,039), and T4 (> 2,039). PIV showed a nonlinear association with mortality. Higher PIV quartiles were linked to increased mortality, with 30-day rates of 26%, 22%, 35%, and 41% (P < 0.001) and 365-day mortality rates of 34%, 31%, 46%, and 54% (P < 0.001). Adjusted hazard ratios (HR) for 30-day mortality across quartiles were 1.00 (reference), 1.04(0.82, 1.31), 1.54 (1.25, 1.9), and 1.62 (1.32, 1.98), respectively. For 365-day mortality, the HR and 95% CI were 1.00 (reference), 1.06 (0.87, 1.30), 1.58 (1.32, 1.90), and 1.70 (1.42, 2.03). After adding PIV to SOFA score, the integrated discrimination improvement (IDI) for 30-day mortality was 0.005, and the net reclassification improvement (NRI) was 0.103. For 365-day mortality, the IDI was 0.009, and the NRI was 0.124. Regarding the APACHE II score, the IDI for 30-day mortality was 0.003, and the NRI was 0.081. For 365-day mortality, the IDI was 0.006, and the NRI was 0.107. Conclusion Elevated PIV independently predicts both short- and long-term adverse outcomes in SA-AKI patients. Incorporating PIV into established critical illness prediction models, such as SOFA and APACHE II, enhances their prognostic accuracy. |
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| institution | OA Journals |
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| publishDate | 2025-04-01 |
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| spelling | doaj-art-d986e25fb7b64bb8b6792f2a2adf4df72025-08-20T02:12:03ZengBMCBMC Infectious Diseases1471-23342025-04-0125111410.1186/s12879-025-10880-zThe association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injuryYidan Zhou0Jingjing Hu1Department of Emergency Medicine, Hangzhou Third People’s HospitalDepartment of Emergency Medicine, Hangzhou Third People’s HospitalAbstract Background Sepsis-associated acute kidney injury (SA-AKI) significantly impacts global health. Early identification of SA-AKI patients at inflammatory and immune risk, followed by timely interventions, is critical for improving outcomes. The pan-immune-inflammation value (PIV) reflects systemic inflammation and immune status. However, its prognostic value in SA-AKI remains unexplored. Methods This retrospective cohort study analyzed SA-AKI patients in the MIMIC-IV database. Cox regression assessed the association between PIV and mortality, while restricted cubic spline (RCS) regression explored the relationship between PIV and 30-day and 365-day mortality. Results A total of 2,473 SA-AKI patients in our study were categorized into PIV quartiles: T1 (≤ 214), T2 (214–679), T3 (679–2,039), and T4 (> 2,039). PIV showed a nonlinear association with mortality. Higher PIV quartiles were linked to increased mortality, with 30-day rates of 26%, 22%, 35%, and 41% (P < 0.001) and 365-day mortality rates of 34%, 31%, 46%, and 54% (P < 0.001). Adjusted hazard ratios (HR) for 30-day mortality across quartiles were 1.00 (reference), 1.04(0.82, 1.31), 1.54 (1.25, 1.9), and 1.62 (1.32, 1.98), respectively. For 365-day mortality, the HR and 95% CI were 1.00 (reference), 1.06 (0.87, 1.30), 1.58 (1.32, 1.90), and 1.70 (1.42, 2.03). After adding PIV to SOFA score, the integrated discrimination improvement (IDI) for 30-day mortality was 0.005, and the net reclassification improvement (NRI) was 0.103. For 365-day mortality, the IDI was 0.009, and the NRI was 0.124. Regarding the APACHE II score, the IDI for 30-day mortality was 0.003, and the NRI was 0.081. For 365-day mortality, the IDI was 0.006, and the NRI was 0.107. Conclusion Elevated PIV independently predicts both short- and long-term adverse outcomes in SA-AKI patients. Incorporating PIV into established critical illness prediction models, such as SOFA and APACHE II, enhances their prognostic accuracy.https://doi.org/10.1186/s12879-025-10880-zPan-immune-inflammation valueSepsisAcute kidney injuryMortality |
| spellingShingle | Yidan Zhou Jingjing Hu The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury BMC Infectious Diseases Pan-immune-inflammation value Sepsis Acute kidney injury Mortality |
| title | The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury |
| title_full | The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury |
| title_fullStr | The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury |
| title_full_unstemmed | The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury |
| title_short | The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury |
| title_sort | association between pan immune inflammation value with mortality in critically ill patients with sepsis associated acute kidney injury |
| topic | Pan-immune-inflammation value Sepsis Acute kidney injury Mortality |
| url | https://doi.org/10.1186/s12879-025-10880-z |
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