Pan-immune-inflammation value and platelet indices as mortality markers in intensive care patients with sepsis

Yıl 2026, Cilt: 7 Sayı: 1, 10 - 18, 06.01.2026

Adil Uğur Çetin , Ece Ünal Çetin , Özge Kurtkulağı , Murat Daş , Esen Şimşek , Fatih Kamış , Ferhan Demirer Aydemir , Yavuz Beyazıt

Öz

Objective: Sepsis remains a major global health problem with high morbidity and mortality rates, mostly in intensive care unit (ICU) settings. The Pan-Immune Inflammation Value (PIIV), a composite marker derived from neutrophil, monocyte, platelet, and lymphocyte counts, has recently emerged as a potential indicator of systemic inflammation. This study aimed to evaluate the prognostic performance of PIIV and platelet-derived indices, including mean platelet volume (MPV) in predicting 30-day mortality among ICU-admitted sepsis patients.
Methods: This retrospective study included 191 adult patients with sepsis admitted to the ICU of a tertiary care hospi-tal. Laboratory parameters, including PIIV, MPV, PLR, and lactate, along with various clinical and laboratory parame-ters were recorded within the first 24 hours of ICU admission. Logistic regression analysis (LRA) and receiver operat-ing characteristic curve (ROC) analysis were performed to determine predictors of 30-day mortality.
Results: Of the total cohort, 96 patients (50.3%) died within 30 days after ICU admission. PIIV, MPV, and lactate levels were found to be elevated in non-survivors (p=0.001, p=0.003, and p=0.001, respectively). In multivariate LRA, PIIV (OR: 1.235; 95% CI: 1.086–1.404; p=0.001), MPV (OR: 1.346; 95% CI: 1.111–1.630; p=0.002), lactate, and urea were independently associated with mortality. ROC analysis showed that PIIV had an AUROC of 0.643 at a cut-off value of ≥1.2, while MPV had an AUROC of 0.623 at a cut-off of ≥11.5 fL.
Conclusion: Integrating PIIV and MPV into the clinical assessment of sepsis patients may improve decision-making in the management of critically ill septic patients in intensive care units.

Anahtar Kelimeler

Sepsis , prognosis , mortality , pan-immune-inflammation value , platelet indices

Etik Beyan

-The study was approved by the local Ethics Committee of Çanakkale Onsekiz Mart University (Approval No: 2025-YÖNP-0129).

Destekleyen Kurum

none

Teşekkür

none

Yoğun bakım ünitesinde sepsis tanılı hastalarda mortalitenin belirteçleri olarak pan-immün-inflamasyon değeri ve trombosit indeksleri

Öz

Amaç: Sepsis, çoğunlukla yoğun bakım ünitesi (YBÜ) ortamlarında yüksek morbidite ve mortalite oranlarına sahip önemli bir küresel sağlık sorunu olmaya devam etmektedir. Nötrofil, monosit, trombosit ve lenfosit sayımlarından türetilen bir bileşik belirteç olan Pan-İmmün İnflamasyon Değeri (PIIV), son zamanlarda sistemik inflamasyonun potansiyel bir göstergesi olarak ortaya çıkmıştır. Bu çalışma, YBÜ'ye yatırılan sepsis hastalarında 30 günlük mortalit-eyi tahmin etmede PIIV ve ortalama trombosit hacmi (MPV) dahil olmak üzere trombosit kaynaklı endekslerin prog-nostik performansını değerlendirmeyi amaçlamaktadır.
Yöntem: Bu retrospektif çalışmaya, üçüncü basamak bir hastanenin YBÜ'süne yatırılan 191 yetişkin sepsis hastası dahil edilmiştir. YBÜ'ye yatışın ilk 24 saati içinde PIIV, MPV, PLR ve laktat gibi laboratuvar parametreleri ile çeşitli klinik ve laboratuvar parametreleri kaydedilmiştir. 30 günlük mortalitenin öngörücülerini belirlemek için lojistik regresyon analizi (LRA) ve alıcı işletim karakteristik eğrisi (ROC) analizi yapıldı.
Bulgular: Toplam kohorttan 96 hasta (%50,3) yoğun bakım ünitesine yatışından sonraki 30 gün içinde öldü. PIIV, MPV ve laktat düzeylerinin hayatta kalamayan hastalarda yüksek olduğu bulundu (sırasıyla p=0,001, p=0,003 ve p=0,001). Çok değişkenli LRA'da, PIIV (OR: 1,235; %95 GA: 1,086-1,404; p=0,001), MPV (OR: 1,346; %95 GA: 1,111-1,630; p=0,002), laktat ve üre mortalite ile bağımsız olarak ilişkiliydi. ROC analizi, PIIV'in ≥1,2 kesme değerinde 0,643 AUROC değerine sahip olduğunu, MPV'nin ise ≥11,5 fL kesme değerinde 0,623 AUROC değerine sahip olduğunu göstermiştir.
Sonuç: PIIV ve MPV'nin sepsis hastalarının klinik değerlendirmesine entegre edilmesi, yoğun bakım ünitelerinde kritik septik hastaların yönetiminde karar verme sürecini iyileştirebilir.

Anahtar Kelimeler

Sepsis , prognoz , mortalite , pan-immün inflamasyon değeri , trombosit indeksleri

Etik Beyan

Çalışma Çanakkale Onsekiz Mart Üniversitesi Etik Kurulu tarafından onaylandı (Onay No: 2025-YÖNP-0129).

Destekleyen Kurum

yok

Teşekkür

yok

Kaynakça

• 1. Long B, Gottlieb M. Emergency medicine updates: Evaluation and diagnosis of sepsis and septic shock. Am J Emerg Med. 2025;90:169–78
• 2. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: the evolution in definition, pathophysiology, and manage-ment. SAGE Open Med. 2019;7:2050312119835043
• 3. Yin Q, Yin J, Shen L, et al. The early diagnostic value of neutrophil to lymphocyte ratio and platelet to lym-phocyte ratio in neonatal late-onset sepsis. Front Pedi-atr. 2025;13:1483522
• 4. Martinez JM, Espírito Santo A, Ramada D, et al. Diag-nostic accuracy of neutrophil to lymphocyte ratio, plate-let to lymphocyte ratio, and neutro-phil lymphocyte to platelet ratio biomarkers in predict-ing bacteremia and sepsis in immunosuppressive patients with cancer: literature review. Porto Biomed J. 2024;9(3):254
• 5. Barekatain B, Mardani E, Sadeghnia A, et al. Diagnostic value of mean platelet volume, neutrophil-to-lymphocyte ratio, and platelet to lymphocyte ratio for late-onset neonatal sepsis. Int J Prev Med. 2025;16:1
• 6. Chen J, Tu X, Huang M, et al. Prognostic value of plate-let combined with serum procalcitonin in patients with sepsis. Medicine (Baltimore). 2023;102:34:e34953
• 7. Liang P, Yu F. Value of CRP, PCT, and NLR in predic-tion of severity and prognosis of patients with blood-stream infections and sepsis. Front Surg. 2022;9:857218
• 8. Murat B, Murat S, Ozgeyik M, et al. Comparison of pan immune inflammation value with other inflamma-tion markers of long term survival after ST segment ele-vation myocardial infarction. Eur J Clin Invest. 2023;53: e13872
• 9. Shen P, Xu Y, Zhu J, et al. Predictive and prognostic value of preoperative pan immune inflammation value in patients with locally advanced rectal cancer. Biomol Biomed. 2025;25(5):1000–8.
• 10. Çoşkun N, Metin M, Doğan G, et al. PAN Immune inflammation value: a new biomarker for diagnosing appendicitis in children?? BMC Pediatr. 2025;25:165
• 11. Mardan M, Zheng H, Xu Q, et al. Comprehensive analysis of pan-immune inflammation and all-cause mortality in rheumatoid arthritis: a database-driven ap-proach, 1999–2018. Front Immunol. 2025;16:1549955
• 12. Okutan İ, Aci R, Keskin Â, et al. New inflammatory markers associated with disease activity in rheumatoid arthritis: Pan Immune inflammation value, systemic immune inflammation index, and systemic inflammation response index. Reumatologia. 2024;62(6):439–46
• 13. Guven DC, Sahin TK, Erul E, et al. The association between the pan immune inflammation value and cancer prognosis: a systematic review and meta analysis. Can-cers (Basel). 2022;14(11):2675
• 14. Turan YB. The prognostic importance of the pan immune inflammation value in patients with septic shock. BMC Infect Dis. 2024;24(1):69
• 15. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis 3). JAMA. 2016;315(8):801–10
• 16. Jacob S, Jacob SA, Thoppil J. Targeting sepsis through inflammation and oxidative metabolism. World J Crit Care Med. 2025;14(1):101499
• 17. Fucà G, Guarini V, Antoniotti C, et al. The Pan Immune Inflammation Value is a new prognostic biomarker in metastatic colorectal cancer: results from a pooled analysis of the Valentino and TRIBE first line trials. Br J Cancer. 2020;123(3):403–9
• 18. Kuang T, Qiu Z, Wang K, et al. Pan immune inflamma-tion value as a prognostic biomarker for cancer patients treated with immune checkpoint inhibitors. Front Im-munol. 2024;15:1326083
• 19. Zhao W, Liao Q, Feng Y, et al. Association of pan immune inflammation value with mortality in pa-tients with pulmonary embolism: a cohort study. Sci Rep. 2025;15(1):6571
• 20. Uçar M, Yılmaz M, Erdiş E, et al. The importance of Pan Immune Inflammation Value score in locally ad-vanced rectal cancer. Immun Inflamm Dis. 2025;13(7):e70227
• 21. Gambichler T, Schuleit N, Susok L, et al. Prognostic performance of inflammatory biomarkers based on com-plete blood counts in COVID 19 patients. Viruses. 2023;15(9):1920
• 22. Kilinc M, Çelik E, Demir İ, Aydemir S, Akelma H. Association of inflammatory and metabolic markers with mortality in patients with postoperative femur fractures in the intensive care unit. Medicina (Kaunas). 2025;61(3):538
• 23. Xu HB, Xu YH, He Y, et al. Association between admission pan immune inflammation value and short term mortality in septic patients: a retrospective cohort study. Sci Rep. 2024;14(1):15205
• 24. Korniluk A, Koper Lenkiewicz OM, Kamińska J, Kemona H, Dymicka Piekarska V. Mean platelet volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm. 2019;2019:9213074
• 25. Beyazit Y, Sayilir A, Torun S, et al. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2012;36(2):162–8
• 26. Kurt M, Onal IK, Sayilir AY, et al. The role of mean platelet volume in the diagnosis of hepatocellular carci-noma in patients with chronic liver disease. Hepatogas-troenterology. 2012;59(117):1580–2
• 27. Beyazit F, Beyazit Y. Critical variables affecting cord blood MPV and IMA levels in gestational diabetic moth-ers. Pediatr Neonatol. 2015;56(6):441
• 28. Purnak T, Olmez S, Torun S, et al. Mean platelet vol-ume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol. 2013;37(1):41–6
• 29. Levytskyi H, Sheiko V. Predicting the dynamics of organ failure in patients with acute pancreatitis depend-ing on the mean platelet volume. Surg Open Sci. 2024;19:166–71
• 30. Gupta A, Kumar S, Acharya S, et al. Utility of platelet indices as prognostic markers of sepsis: a medical inten-sive care unit based cross sectional study at a rural setup. Cureus. 2024;16(2):e54490
• 31. Djordjevic D, Rondovic G, Surbatovic M, et al. Neu-trophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio, and mean platelet volume to platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of bacteremia? Mediators Inflamm. 2018;2018:3758068
• 32. Wu H, Cao T, Ji T, et al. Predictive value of the neu-trophil to lymphocyte ratio in the prognosis and risk of death for adult sepsis patients: a meta analysis. Front Immunol. 2024;15:1336456
• 33. Patro S, Choudhary A, Sharma V, et al. Evaluating platelet to lymphocyte ratio and systemic im-mune inflammation index as distinctive biomarkers in type 2 diabetes mellitus patients with and without pro-teinuria: a retrospective study. Cureus. 2025;17(2):e79348
• 34. Barekatain B, Mardani E, Sadeghnia A, et al. Diagnos-tic value of mean platelet volume, neutro-phil to lymphocyte ratio, and platelet to lymphocyte ratio for late onset neonatal sepsis. Int J Prev Med. 2025;16:1
• 35. Wang H, Guo C, Wang Y, et al. Immune cell composi-tion and its impact on prognosis in children with sepsis. BMC Pediatr. 2024;24:1:611