{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:09:47Z","timestamp":1784542187527,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis is associated with high mortality and poor prognosis in critically ill patients, posing a severe threat to global public health. The first absolute lymphocyte count (FALC) upon admission to the ICU, reflecting the initial state of the immune system, has emerged as a potential prognostic indicator in various critical illnesses. However, its specific role and predictive value in assessing 28-day mortality among sepsis patients in the ICU remain incompletely understood, with existing studies showing limitations in sample size and verification dimensions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data of ICU patients (18&amp;lt;age&amp;lt;90) who met the sepsis diagnostic criteria (Sepsis-3 definition) were extracted from the MIMIC-IV(2.0) clinical database. Patients were grouped according to the tertiles of FALC (low, medium, high); FALC was the absolute lymphocyte count in the first complete blood count upon admission to the ICU; the outcome indicator was 28-day all-cause mortality. Baseline analysis: For measurement data, normally distributed data were described as mean \u00b1 standard deviation, skewed distributed data as median (Q1-Q3), and count data as frequency (percentage). Differences between groups were tested using t-test, chi-square test, or non-parametric test. Survival analysis: KM method was used to draw survival curves, and log-rank test was used to compare differences between groups; Cox proportional hazards model was used to analyze univariate\/multivariate associations, and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Non-linear verification: RCS model was used to fit the non-linear relationship between FALC and death risk, and the linear hypothesis was tested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Predictive efficacy<\/jats:title>\n                    <jats:p>Cox regression ROC curve was used to calculate the area under the curve (AUC) to evaluate the predictive value of FALC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study of 10,263 sepsis patients admitted to the ICU found that FALC grouping significantly affected 28-day survival outcomes, as shown by Kaplan-Meier survival analysis and Cox regression analysis. Low FALC group having a significantly higher 28-day mortality risk compared to the medium and high groups. Restricted cubic splines verified a non-linear relationship between FALC and 28-days mortality, and the ROC curve confirmed that FALC has a certain prognostic predictive efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In sepsis patients, lymphopenia represents a significant high-risk factor, while the first absolute lymphocyte count (FALC) stands out as a clinically meaningful indicator. It allows for precise risk stratification of patients at the time of ICU admission, thereby enabling timely immune interventions that can effectively enhance prognostic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1688451","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:36:14Z","timestamp":1767594974000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of absolute lymphocyte count upon admission to ICU on 28-day mortality in sepsis patients in 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