ArticleWorld journal of methodology2026
Integrating serum ferritin and neutrophil-to-lymphocyte ratio with Sequential Organ Failure Assessment score improves mortality prediction in sepsis.
Article in World journal of methodology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSepsis causes significant mortality in patients. Typically, the Sequential Organ Failure Assessment (SOFA) score is used; however, recent studies have demonstrated improved predictive accuracy by using inflammatory biomarkers such as serum ferritin and the neutrophil-to-lymphocyte ratio (NLR). Serum ferritin, although traditionally associated with iron metabolism, also acts as an acute-phase reactant reflecting systemic inflammation.
aimTo assess the prognostic value of integrating ferritin and NLR with SOFA in predicting mortality in critically ill patients with sepsis.
methodsMedical Information Mart for Intensive Care database-IV database was used to conduct this retrospective cohort study. Patients were divided into quartiles based on values of serum ferritin and NLR. Cox proportional hazards regression assessed the association with 30-day mortality, adjusted for age, sex, and the Charlson comorbidity index. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), calibration plot, and net reclassification index (NRI). Bootstrapped internal validation was performed using 1000 resamples.
resultsPatients in the ferritin Q1 quartile (lowest ferritin quartile) had 30% lower adjusted mortality risk (hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.57-0.9;
conclusionLower ferritin and NLR are associated with reduced 30-day mortality, with ferritin markedly improving SOFA-based prediction and NLR offering minimal added benefit. Accessible biomarkers enhance early risk assessment in low-resource intensive care units.
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