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. 2025 Apr 9;25(1):486.
doi: 10.1186/s12879-025-10880-z.

The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury

Yidan Zhou  1 , Jingjing Hu  2
Affiliations

The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury

Yidan Zhou et al. BMC Infect Dis. .

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.

Keywords: Acute kidney injury; Mortality; Pan-immune-inflammation value; Sepsis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The MIMIC database was approved by the Institutional Review Boards (IRBs) of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center. This study adhered to the ethical principles of the Declaration of Helsinki and was approved by both institutions. As patient data was de-identified, individual informed consent was not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
The flowchart of patients’ selection
Fig. 2
Fig. 2
Cubic spline plot of the relation between PIV and all-cause mortality (A.30-day; B.365-day. Adjusted for age, gender, race, creatinine, chronic heart failure, lung disease, liver disease, diabetes, hypertension, cancer, SAPS III scores, SOFA scores, APACHE II scores, use of vasopressors, first 24-hour fluid balance, norepinephrine equivalent dose, and presence of urinary tract infection, mechanical ventilation use, and CRRT use.)
Fig. 3
Fig. 3
Kaplan-Meier survival curves for PIV and mortality (A. 30-day mortality; B. 365-day mortality.)
Fig. 4
Fig. 4
Time-dependent ROC of seven indicators for predicting mortality in SA-AKI patients (A. 30-day mortality; B. 365-day mortality.)
Fig. 5
Fig. 5
Performance of the predictive models for mortality in SA-AKI patients (A. 30-day mortality; B. 365-day mortality.)
Fig. 6
Fig. 6
Subgroup and interaction analysis of PIV and 30-day mortality
Fig. 7
Fig. 7
Subgroup and interaction analysis of PIV and 365-day mortality
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