Association between neutrophil to high-density lipoprotein cholesterol ratio and 28-day mortality in sepsis patients: Analysis from the MIMIC-IV database

The neutrophil count-to-high-density lipoprotein cholesterol ratio (NHR), a composite biomarker of lipid metabolism and inflammation, has been regarded as an indicator for predicting clinical outcomes in patients suffering from acute cardiovascular and cerebrovascular disorders. However, the association between the NHR and 28-day all-cause mortality in the sepsis population remains unclear. Our study population comprised 1018 sepsis patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV V2.2) database who were grouped into tertiles based on their NHRs. In this study, curve fitting and 2-piecewise regression models were utilized to analyze the dose-response relationship between the Log NHR and 28-day mortality. The mean age of the participants in the study cohort was 65.0 ± 15.7 years, and 56.3% were men. The 28-day mortality rates for the NHR tertiles were 15% (51), 13.3% (45), and 18.2% (62). By investigating the Log NHR and 28-day mortality, we observed a clear U-shaped relationship. Threshold saturation analysis revealed that when Log NHR below 1.87 (NHR 6.50), with each 1-unit increase in the Log NHR, the risk of 28-day mortality significantly decreased (HR = 0.61, 95% confidence interval: 0.37, 1.01, P = .0526). Conversely, the logNHR for 28-day mortality increased beyond 1.87 (HR = 1.72, 95% confidence interval: 1.18, 2.51; P = .0045). Stratified by age, our analysis revealed nuanced variations in the Log NHR and 28-day mortality association across different age groups. This study revealed a robust U-shaped relationship between the Log NHR and 28-day all-cause mortality in the sepsis population, with a critical threshold of Log NHR = 1.87 (NHR 6.50). This risk is influenced by age.