{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:07:19Z","timestamp":1793412439452,"version":"4.5.0"},"reference-count":43,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union","award":["J93C23000690008"],"award-info":[{"award-number":["J93C23000690008"]}]},{"name":"European Union","award":["D70-RINTG23BIOLO_01"],"award-info":[{"award-number":["D70-RINTG23BIOLO_01"]}]},{"name":"European Union","award":["2023-14-U.0"],"award-info":[{"award-number":["2023-14-U.0"]}]},{"name":"Italian Space Agency (ASI) project","award":["J93C23000690008"],"award-info":[{"award-number":["J93C23000690008"]}]},{"name":"Italian Space Agency (ASI) project","award":["D70-RINTG23BIOLO_01"],"award-info":[{"award-number":["D70-RINTG23BIOLO_01"]}]},{"name":"Italian Space Agency (ASI) project","award":["2023-14-U.0"],"award-info":[{"award-number":["2023-14-U.0"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Insulin-like growth factor-binding protein-3 (IGFBP-3) plays a vital role in cellular growth, development, and survival. Incorporating IGFBP-3 into baseline prognostic evaluations may enhance the prediction of mortality in patients with sepsis. In this study, serum levels of IGFBP-3, C-reactive protein, procalcitonin, lactate, interleukin-6, and mid-regional pro-adrenomedullin were measured upon admission to the internal medicine unit (IMU) in 139 patients with microbiologically confirmed sepsis. The objectives were as follows: (1) to classify septic patient phenotypes based on optimal thresholds of independent prognostic biomarkers and (2) to evaluate whether these biomarkers improve the predictive accuracy of a clinical model (Model 1), which includes the clinical predictors of 1-year mortality. Age, sequential organ failure assessment (SOFA) score, multiple sources of infection, and IGFBP-3 levels independently predicted 1-year mortality. Patients with IGFBP-3 levels below 10.64 had significantly lower median body temperature (p = 0.008), reduced lymphocyte count (p = 0.001), and higher 1-year mortality (p &lt; 0.001). Model 1 included age, SOFA score, and the presence of multiple sources of sepsis as predictor variables. Model 2 incorporated the same variables as Model 1, with the addition of IGFBP-3 levels. When comparing their prognostic performance, Model 2 demonstrated superior predictive accuracy for mortality at 60, 90, and 365 days following admission to the IMU. Low IGFBP-3 levels at IMU admission are strongly associated with worse outcomes in septic patients, supporting its potential use as a prognostic biomarker.<\/jats:p>","DOI":"10.3390\/ijms26146549","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:18:11Z","timestamp":1751948291000},"page":"6549","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Lower Initial Insulin-like Growth Factor-Binding Protein-3 Concentrations May Reflect Immune Suppression and Predict Increased Risk of Sepsis-Related Mortality"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5862-9077","authenticated-orcid":false,"given":"Filippo","family":"Mearelli","sequence":"first","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8818-1322","authenticated-orcid":false,"given":"Alessio","family":"Nunnari","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Chitti","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Rombini","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Scardino","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Martini","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Bolzan","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Spagnol","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Casarsa","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8918-7622","authenticated-orcid":false,"given":"Nicola","family":"Fiotti","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine, Clinica Medica, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9204-032X","authenticated-orcid":false,"given":"Verena","family":"Zerbato","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Clinical Departement of Medical, Surgical, and Health Sciences, University Hospital (ASUGI), Piazzale dell\u2019Ospedale n\u00b0 1, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6121-7009","authenticated-orcid":false,"given":"Stefano","family":"Di Bella","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Clinical Departement of Medical, Surgical, and Health Sciences, University Hospital (ASUGI), Piazzale dell\u2019Ospedale n\u00b0 1, 34100 Trieste, 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