Advanced lung cancer inflammation index and all-cause mortality in critically ill patients with sepsis: analysis of the MIMIC-IV database

The advanced lung cancer inflammation index (ALI) has been shown to associate with the outcome in many diseases. This study aimed to explore the association between ALI and all-cause mortality in critically ill patients with sepsis. This is a retrospective observational cohort study and data are obtained from the Medical Information Mart for Intensive Care-IV (MIMIC IV 3.0) database, which included 8133 patients with sepsis and had the measurement of ALI. The participants were divided into four groups based on the quartiles of ALI. The study endpoints were 30-day and 360-day all-cause mortality. A total of 8133 patients were included in this study. The mortatliy decreased as ALI increased from Q1 to Q4 group. Multivariable Cox regression analysis observed compared with patients in Q1, patients in Q2, Q3, and Q4 had reduced risk of 30-day all-cause mortality (Q2 vs. Q1 HR = 0.871, 95%CI 0.779, 0.974, p = 0.015; Q3 vs. Q1 HR = 0.779, 95%CI 0.689, 0.881, p < 0.001; Q4 vs. Q1 HR = 0.753, 95%CI 0.660, 0.858, p < 0.001) and 360-day all-cause mortality (Q2 vs. Q1 HR = 0.886, 95%CI 0.809, 0.971, p = 0.009; Q3 vs. Q1 HR = 0.810, 95%CI 0.734, 0.894, p < 0.001; Q4 vs. Q1 HR = 0.780, 95%CI 0.702, 0.868, p < 0.001). Restricted cubic spline analysis revealed a non-linear association between ALI and 30-day and 360-day all-cause mortality and the risk increased more significantly as ALI decreased when ALI < 7.961. Sensitivity analysis indicated that the effect of ALI on different subgroup patients were consistent except in patients with or without liver disease. ALI was negatively associated with short-term and long-term all-cause mortality in patients with sepsis. ALI could serve as a marker for risk stratification and the subsequent interventions in patients with sepsis. However, more studies are warranted to validate our findings.