Diagnostic utility of the modified inflammatory burden index and PCT/LYM ratio for sepsis stratification and early prediction of septic shock.
- 1Department of Laboratory Medicine, Kaifeng Central Hospital, Kaifeng, Henan, China.
- 2Key Laboratory of Tumor Biological Marker Detection of Kaifeng, Kaifeng, Henan, China.
Abstract
Objective
This study aimed to investigate the diagnostic performance of a modified inflammatory burden index (mIBI) and conventional biomarkers in sepsis and septic shock and assess the clinical utility of their combined application with the PCT/LYM ratio.Methods
A retrospective analysis included 45 patients with sepsis, 77 with septic shock, and 54 with non-septic infectious inflammation (control). Levels of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), neutrophil count (NEU), and lymphocyte count (LYM) were measured. Composite indices including mIBI, PCT/LYM, CRP/LYM, and NLR were calculated. Multivariable logistic regression evaluated the independent diagnostic value of mIBI and PCT/LYM after adjusting for confounders.Results
Inflammatory markers and composite indices increased progressively from control to sepsis to septic shock, whereas LYM decreased (all P < 0.05). For sepsis diagnosis, PCT/LYM showed strong diagnostic performance (AUC = 0.851, 95% CI: 0.775-0.928; sensitivity 80.00%, specificity 81.48% at cutoff 0.91), followed by mIBI (AUC = 0.806, specificity 88.89%). For septic shock, PCT/LYM (AUC = 0.880) and mIBI (AUC = 0.877) were comparable to PCT and IL-6 (all AUC = 0.879). Multivariable analysis revealed that after adjustment for age, sex, qSOFA, diabetes, and renal insufficiency, both log₁₀(mIBI) (OR = 2.771, P < 0.001) and PCT/LYM (OR = 1.045, P = 0.002) were independent predictors for sepsis. For septic shock, log₁₀(mIBI) retained independent predictive capacity (OR = 1.399, P = 0.030), whereas PCT/LYM showed a borderline association (OR = 1.004, P = 0.053).Conclusion
The composite framework integrating PCT/LYM and mIBI addresses limitations of single biomarkers. PCT/LYM demonstrated independent predictive value, with a numerically higher AUC than PCT alone for both sepsis and septic shock, although the direct DeLong comparison did not reach statistical significance, supporting its potential utility as part of a composite screening approach. Modified IBI showed strong independent diagnostic value for sepsis and high univariate discriminative ability for septic shock. These routinely available indicators offer timely, cost-effective advantages for early sepsis identification and risk stratification.
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BibTeX
@article{ding2026diagnostic,
title = {{Diagnostic utility of the modified inflammatory burden index and PCT/LYM ratio for sepsis stratification and early prediction of septic shock.}},
author = {Zhen-Zhen Ding and Qian Li and Chun-Yan Ma and Hang Li},
journal = {Frontiers in cellular and infection microbiology},
year = {2026},
month = oct,
doi = {10.3389/fcimb.2026.1845721},
url = {https://europepmc.org/article/MED/42908649},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic utility of the modified inflammatory burden index and PCT/LYM ratio for sepsis stratification and early prediction of septic shock.
AU - Zhen-Zhen Ding
AU - Qian Li
AU - Chun-Yan Ma
AU - Hang Li
PY - 2026
DA - 2026/10/07
JO - Frontiers in cellular and infection microbiology
DO - 10.3389/fcimb.2026.1845721
UR - https://europepmc.org/article/MED/42908649
AB - Objective This study aimed to investigate the diagnostic performance of a modified inflammatory burden index (mIBI) and conventional biomarkers in sepsis and septic shock and assess the clinical utility of their combined application with the PCT/LYM ratio.Methods A retrospective analysis included 45 patients with sepsis, 77 with septic shock, and 54 with non-septic infectious inflammation (control). Levels of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), neutrophil count (NEU), and lymphocyte count (LYM) were measured. Composite indices including mIBI, PCT/LYM, CRP/LYM, and NLR were calculated. Multivariable logistic regression evaluated the independent diagnostic value of mIBI and PCT/LYM after adjusting for confounders.Results Inflammatory markers and composite indices increased progressively from control to sepsis to septic shock, whereas LYM decreased (all P < 0.05). For sepsis diagnosis, PCT/LYM showed strong diagnostic performance (AUC = 0.851, 95% CI: 0.775-0.928; sensitivity 80.00%, specificity 81.48% at cutoff 0.91), followed by mIBI (AUC = 0.806, specificity 88.89%). For septic shock, PCT/LYM (AUC = 0.880) and mIBI (AUC = 0.877) were comparable to PCT and IL-6 (all AUC = 0.879). Multivariable analysis revealed that after adjustment for age, sex, qSOFA, diabetes, and renal insufficiency, both log₁₀(mIBI) (OR = 2.771, P < 0.001) and PCT/LYM (OR = 1.045, P = 0.002) were independent predictors for sepsis. For septic shock, log₁₀(mIBI) retained independent predictive capacity (OR = 1.399, P = 0.030), whereas PCT/LYM showed a borderline association (OR = 1.004, P = 0.053).Conclusion The composite framework integrating PCT/LYM and mIBI addresses limitations of single biomarkers. PCT/LYM demonstrated independent predictive value, with a numerically higher AUC than PCT alone for both sepsis and septic shock, although the direct DeLong comparison did not reach statistical significance, supporting its potential utility as part of a composite screening approach. Modified IBI showed strong independent diagnostic value for sepsis and high univariate discriminative ability for septic shock. These routinely available indicators offer timely, cost-effective advantages for early sepsis identification and risk stratification.
SN - 2235-2988
ER -