Inflammatory Indices for Predicting Mechanical Ventilation and 30-Day Mortality in ICU Pneumosepsis: A Retrospective Cohort Study
Güliz Evik1, Mete Üçdal2, Ebru Aykan Mavigöz31Department of Infectious Diseases and Clinical Microbiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Türkiye2Department of Internal Medicine, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Türkiye
3Department of Pulmonology and Critical Care, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Türkiye
Objectives: The prognostic value of inflammatory and immunonutritional indices in intensive care unit (ICU) pneumosepsis remains uncer-tain. We evaluated eight routinely calculable indices for predicting invasive mechanical ventilation (IMV) and 30-day mortality.
Methods: This retrospective single-center cohort included consecutive adults with Sepsis-3-defined pneumosepsis admitted from the emergency department to the ICU between 2022 and 2024. Indices were calculated from complete blood count, albumin, and C-reactive protein values obtained within six hours of presentation. Discrimination was assessed by receiver operating characteristic analysis. Multivariable logistic and Cox regression models evaluated independent associations with IMV and mortality, respectively.
Results: Among 284 patients, 167 (58.8%) required IMV, and 112 (39.4%) died within 30 days. Non-survivors had higher Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index, Aggregate Index of Systemic Inflammation, and neutrophil-to-lymphocyte ratio values but lower Prognostic Nutritional Index, C-reactive protein-albumin-lymphocyte (CALLY) index, and Hemoglobin-Albumin-Lymphocyte-Platelet scores. CALLY showed the highest discrimination for 30-day mortality (area under the curve [AUC], 0.821), followed by SII (AUC, 0.798). SII (AUC, 0.784) and the neutrophil-to-lymphocyte ratio (AUC, 0.762) performed best for IMV. After adjustment for age, Sequential Organ Failure Assessment score, and Charlson Comorbidity Index, SII >2,156 (hazard ratio, 2.14; 95% confidence interval, 1.42-3.22) and CALLY <1.12 (hazard ratio, 2.67; 95% confidence interval, 1.78-4.01) independently predicted mortality (both p<0.001).
Conclusion: Admission inflammatory indices provide early prognostic information in ICU pneumosepsis. CALLY and SII may complement established severity scores and support early risk stratification. These inexpensive biomarkers may facilitate triage, resource allocation, and escalation of care while awaiting comprehensive clinical assessment.
Keywords: Biomarkers, intensive care units, mortality, pneumonia, sepsis
Manuscript Language: English
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