{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T10:14:41Z","timestamp":1782123281335,"version":"3.54.5"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"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. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aims to explore the value of the Lymphocyte-to-Monocyte Ratio (LMR) in predicting delirium among older adult patients with sepsis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective data were obtained from the MIMIC-IV database in accordance with the STROBE guidelines. Patients aged 65 and above, meeting the Sepsis 3.0 criteria, were selected for this study. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Demographic information, comorbid conditions, severity of illness scores, vital sign measurements, and laboratory test results were meticulously extracted. The prognostic utility of the Lymphocyte-to-Monocyte Ratio (LMR) in predicting delirium was assessed through logistic regression models, which were carefully adjusted for potential confounding factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the studied cohort of 32,971 sepsis patients, 2,327 were identified as meeting the inclusion criteria. The incidence of delirium within this subgroup was observed to be 55%. A univariate analysis revealed a statistically significant inverse correlation between the Lymphocyte-to-Monocyte Ratio (LMR) and the risk of delirium (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Subsequent multivariate analysis, which accounted for comorbidities and illness severity scores, substantiated the role of LMR as a significant predictive marker. An optimized model, achieving the lowest Akaike Information Criterion (AIC), incorporated 17 variables and continued to demonstrate LMR as a significant prognostic factor (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01). Analysis of the Receiver Operating Characteristic (ROC) curve indicated a significant enhancement in the Area Under the Curve (AUC) upon the inclusion of LMR (<jats:italic>p<\/jats:italic>\u2009=\u20090.035).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The Lymphocyte-to-Monocyte Ratio (LMR) serves as a significant, independent prognostic indicator for the occurrence of delirium in older adult patients with sepsis. Integrating LMR into existing predictive models markedly improves the identification of patients at elevated risk, thereby informing and potentially guiding early intervention strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1342568","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T04:17:00Z","timestamp":1706674620000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Evaluating early lymphocyte-to-monocyte ratio as a predictive biomarker for delirium in older adult patients with sepsis: insights from a retrospective cohort analysis"],"prefix":"10.3389","volume":"11","author":[{"given":"Xiaopeng","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weimin","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijie","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit Care Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.4161\/viru.27372","article-title":"Epidemiology of severe sepsis","volume":"5","author":"Mayr","year":"2014","journal-title":"Virulence"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1097\/CCM.0b013e318241e51e","article-title":"Relationship between neighborhood poverty rate and bloodstream infections in the critically ill","volume":"40","author":"Mendu","year":"2012","journal-title":"Crit Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"102844","DOI":"10.1016\/j.iccn.2020.102844","article-title":"Risk factors and outcomes of sepsis-associated delirium in intensive care unit patients: a secondary data analysis","volume":"59","author":"Kim","year":"2020","journal-title":"Intensive Crit Care Nurs"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1007\/s10753-019-00964-9","article-title":"Short-term effects of Sepsis and the impact of aging on the transcriptional profile of different brain regions","volume":"42","author":"Hamasaki","year":"2019","journal-title":"Inflammation"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3390\/medicina56050240","article-title":"Sepsis associated delirium","volume":"56","author":"Atterton","year":"2020","journal-title":"Medicina (Kaunas)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"58","DOI":"10.5498\/wjp.v2.i4.58","article-title":"Assessment scales for delirium: a review","volume":"2","author":"Grover","year":"2012","journal-title":"World J Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"12697","DOI":"10.1038\/s41598-023-38650-4","article-title":"Development of a machine learning-based prediction model for sepsis-associated delirium in the intensive care unit","volume":"13","author":"Zhang","year":"2023","journal-title":"Sci Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1097\/CCM.0000000000004139","article-title":"Biomarkers of delirium duration and delirium severity in the ICU","volume":"48","author":"Khan","year":"2020","journal-title":"Crit Care Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s00240-022-01319-0","article-title":"Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) in predicting systemic inflammatory response syndrome (SIRS) and sepsis after percutaneous nephrolithotomy (PNL)","volume":"50","author":"Kriplani","year":"2022","journal-title":"Urolithiasis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.3390\/jcm12041273","article-title":"Sepsis-associated delirium: a narrative review","volume":"12","author":"Tokuda","year":"2023","journal-title":"J Clin Med"},{"key":"ref13","volume-title":"MIMIC-IV (version 2.2)","author":"Johnson","year":"2023"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1001\/jama.2017.12126","article-title":"Discrimination and calibration of clinical prediction models: Users\u2019 guides to the medical literature","volume":"318","author":"Alba","year":"2017","journal-title":"JAMA"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14343","article-title":"Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery","author":"Chen","year":"2023","journal-title":"CNS neuroscience & therapeutics"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"558","DOI":"10.4097\/kja.19087","article-title":"Multicollinearity and misleading statistical results","volume":"72","author":"Kim","year":"2019","journal-title":"Korean J Anesthesiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/s13311-020-00862-1","article-title":"Septic-associated encephalopathy: a comprehensive review","volume":"17","author":"Mazeraud","year":"2020","journal-title":"Neurotherapeutics"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/s00134-007-0622-2","article-title":"Sepsis-associated delirium","volume":"33","author":"Ebersoldt","year":"2007","journal-title":"Intensive Care Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit","volume":"291","author":"Ely","year":"2004","journal-title":"JAMA"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"828","DOI":"10.3760\/cma.j.issn.0366-6999.2012.05.018","article-title":"Epidemiological features and risk factors of sepsis-associated encephalopathy in intensive care unit patients: 2008-2011","volume":"125","author":"Zhang","year":"2012","journal-title":"Chin Med J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s00134-017-4807-z","article-title":"Potentially modifiable factors contributing to sepsis-associated encephalopathy","volume":"43","author":"Sonneville","year":"2017","journal-title":"Intensive Care Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/CCM.0000000000000625","article-title":"A systematic review of risk factors for delirium in the ICU","volume":"43","author":"Zaal","year":"2015","journal-title":"Crit Care Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1097\/ALN.0000000000001378","article-title":"Intensive care unit delirium: a review of diagnosis, prevention, and treatment","volume":"125","author":"Hayhurst","year":"2016","journal-title":"Anesthesiology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1946","DOI":"10.1097\/CCM.0b013e31824e16c9","article-title":"Delirium screening in critically ill patients: a systematic review and meta-analysis","volume":"40","author":"Neto","year":"2012","journal-title":"Crit Care Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1342568\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T04:17:04Z","timestamp":1706674624000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1342568\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,31]]},"references-count":26,"alternative-id":["10.3389\/fmed.2024.1342568"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1342568","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,31]]},"article-number":"1342568"}}