Impact of absolute lymphocyte count upon admission to ICU on 28-day mortality in sepsis patients in ICU

Background: Sepsis is associated with high mortality and poor prognosis in critically ill patients, posing a severe threat to global public health. The first absolute lymphocyte count (FALC) upon admission to the ICU, reflecting the initial state of the immune system, has emerged as a potential prognostic indicator in various critical illnesses. However, its specific role and predictive value in assessing 28-day mortality among sepsis patients in the ICU remain incompletely understood, with existing studies showing limitations in sample size and verification dimensions. Methods: Data of ICU patients (18<age<90) who met the sepsis diagnostic criteria (Sepsis-3 definition) were extracted from the MIMIC-IV(2.0) clinical database. Patients were grouped according to the tertiles of FALC (low, medium, high); FALC was the absolute lymphocyte count in the first complete blood count upon admission to the ICU; the outcome indicator was 28-day all-cause mortality. Baseline analysis: For measurement data, normally distributed data were described as mean ± standard deviation, skewed distributed data as median (Q1-Q3), and count data as frequency (percentage). Differences between groups were tested using t-test, chi-square test, or non-parametric test. Survival analysis: KM method was used to draw survival curves, and log-rank test was used to compare differences between groups; Cox proportional hazards model was used to analyze univariate/multivariate associations, and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Non-linear verification: RCS model was used to fit the non-linear relationship between FALC and death risk, and the linear hypothesis was tested. Predictive efficacy: Cox regression ROC curve was used to calculate the area under the curve (AUC) to evaluate the predictive value of FALC. Results: The study of 10,263 sepsis patients admitted to the ICU found that FALC grouping significantly affected 28-day survival outcomes, as shown by Kaplan-Meier survival analysis and Cox regression analysis. Low FALC group having a significantly higher 28-day mortality risk compared to the medium and high groups. Restricted cubic splines verified a non-linear relationship between FALC and 28-days mortality, and the ROC curve confirmed that FALC has a certain prognostic predictive efficacy. Conclusion: In sepsis patients, lymphopenia represents a significant high-risk factor, while the first absolute lymphocyte count (FALC) stands out as a clinically meaningful indicator. It allows for precise risk stratification of patients at the time of ICU admission, thereby enabling timely immune interventions that can effectively enhance prognostic outcomes.