Admission inflammatory and immuno-nutritional indices and in-hospital mortality in emergency department patients admitted to intensive care: a retrospective cohort study.

Authors

Mustafa Enes Demirel, Ahmet Celal Çapkan, Samet Sezer Can, Muhammed Ali Binzet

Published in

Frontiers in medicine. Volume 13. Pages 1903440. Epub Jul 20, 2026.

Abstract

This study investigated whether admission-based composite inflammatory indices and C-reactive protein-to-albumin ratio (CAR) were associated with in-hospital mortality in adult patients admitted from the emergency department to the intensive care unit.
This retrospective cohort study included 709 adult patients admitted to the intensive care unit (ICU) via the emergency department. Inflammatory and immuno-nutritional indices at the time of admission, including C-reactive protein/albumin ratio (CAR) and three Multi-Inflammatory Index variants were evaluated. MII-1, MII-2, and MII-3 were calculated as neutrophil to lymphocyte ratio × CRP, platelet to lymphocyte ratio × CRP, and systemic immune-inflammation index × CRP, respectively. Associations with in-hospital mortality were assessed using unadjusted analyses, age- and sex-adjusted Cox regression models and descriptive receiver operating characteristic analyses.
Non-survivors exhibited significantly higher median MII values and CAR levels compared with survivors in unadjusted analyses (p < 0.001). In SD-scaled age- and sex-adjusted Cox analyses, CAR and all three MII variants were associated with in-hospital mortality. However, ROC analyses showed limited discriminatory performance for these indices. CAR showed the most consistent association with mortality, including in the sensitivity analysis adjusted for GCS score and oncologic disease status. Discriminative performance was modest for all indices, with CAR showing higher area under the curve values (AUC: 0.627) compared with MII variants (AUC range: 0.579-0.595).
MII variants and CAR were associated with mortality in admission-based analyses. However, their discriminatory performance was limited. Overall, these findings support the interpretation of admission-based inflammatory indices as adjunctive markers of inflammatory burden rather than standalone prognostic tools in emergency-to-ICU patients.

PMID:
42548816
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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