用免疫标记物增强SOFA-2，以捕捉疑似感染患者失调的宿主反应
Augmenting SOFA-2 with immune markers to capture dysregulated host response in patients with suspected infection.
摘要(中文译文)
更新后的SOFA-2评分因特异性方面的顾虑而排除了免疫系统，鉴于脓毒症的定义即为宿主反应失调，这造成了概念上的缺口。我们假设，在SOFA-2中加入广泛可用的免疫标志物——白细胞计数、淋巴细胞计数及中性粒细胞与淋巴细胞比值（NLR）——将改善疑似感染患者的死亡预测。我们分析了来自MIMIC-IV、MIMIC-III和eICU数据库的75,203例成人患者。我们采用细胞计数的暂定共识标准和通过广义相加模型得出的NLR数据驱动阈值，构建了免疫增强型SOFA-2模型。通过受试者工作特征曲线下面积（AUROC）的随机效应荟萃分析和净重分类改善（NRI）来评估区分能力。免疫增强模型在所有队列中均显著优于标准SOFA-2。在汇总分析中，免疫增强型SOFA-2的AUROC（0.750 [95% CI，0.715-0.785]）高于标准SOFA-2（0.740 [95% CI，0.712-0.768]；p=0.003）。此外，纳入免疫标志物改善了临床风险分层，汇总总NRI显著为0.046（95% CI，0.014-0.078；p=0.005）。排除免疫系统限制了SOFA-2评分捕捉严重感染所必需的宿主反应失调的能力。整合免疫标志物可显著提高疑似感染患者的预后准确性和风险重分类。
Abstract
The updated SOFA-2 score excludes the immune system due to specificity concerns, creating a conceptual gap given that sepsis is defined by a dysregulated host response. We hypothesized that augmenting SOFA-2 with widely available immune markers-white blood cell counts, lymphocyte counts, and the neutrophil-to-lymphocyte ratio (NLR)-would improve mortality prediction in patients with suspected infection. We analyzed 75,203 adult patients from the MIMIC-IV, MIMIC-III, and eICU databases. We constructed an immune-augmented SOFA-2 model using provisional consensus criteria for cell counts and data-driven thresholds for NLR derived via generalized additive models. Discrimination was evaluated using random-effects meta-analysis of the area under the receiver operating characteristic (AUROC) curve and net reclassification improvement (NRI). The immune-augmented model significantly outperformed standard SOFA-2 across all cohorts. In the pooled analysis, the immune-augmented SOFA-2 yielded a higher AUROC (0.750 [95% CI, 0.715-0.785]) compared to standard SOFA-2 (0.740 [95% CI, 0.712-0.768]; p=0.003). Additionally, incorporating immune markers improved clinical risk stratification, resulting in a significant pooled total NRI of 0.046 (95% CI, 0.014-0.078; p=0.005). Excluding the immune system limits the ability of the SOFA-2 score to capture the dysregulated host response essential to severe infection. Integrating immune markers significantly enhances prognostic accuracy and risk reclassification for patients with suspected infection.
如何引用
AMA
Yu Qi, Huihui Sun, Chunhong Hou. Augmenting SOFA-2 with immune markers to capture dysregulated host response in patients with suspected infection.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1904045.
APA
Yu Qi, Huihui Sun, Chunhong Hou (2026). Augmenting SOFA-2 with immune markers to capture dysregulated host response in patients with suspected infection.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1904045
GB/T 7714
Yu Qi, Huihui Sun, Chunhong Hou. Augmenting SOFA-2 with immune markers to capture dysregulated host response in patients with suspected infection.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1904045.
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