{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:05:20Z","timestamp":1784624720059,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Science and Technology Research Foundation of Guangdong Province","award":["B2025783"],"award-info":[{"award-number":["B2025783"]}]},{"name":"Nursing Scientific Research Funds of the Third Affiliated Hospital of Sun Yat-sen University","award":["2023HLMS03"],"award-info":[{"award-number":["2023HLMS03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Surgical sepsis complicated by acute kidney injury (AKI) is associated with high mortality, and early risk stratification remains challenging. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, reflects nutritional and immune status, but its prognostic value in surgical sepsis with AKI has not been well defined. Methods: In this retrospective cohort study based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) (version 3.1) database, we included adult patients admitted to a surgical or surgery-related intensive care unit (ICU) between 2008 and 2022 who met the Sepsis-3 criteria and developed AKI according to KDIGO. The primary endpoint was 90-day all-cause mortality. We used multivariable Cox proportional hazards models, restricted cubic splines, Kaplan\u2013Meier analysis, and predefined subgroup analyses to examine the association between PNI at ICU admission and 90-day mortality. Results: A total of 1483 patients were included, with a 90-day mortality rate of 30.2%. Non-survivors had a lower median PNI than survivors (35 vs. 36, p &lt; 0.001). After sequential adjustment for demographics, comorbidities, illness severity, and major interventions, each 1-point increase in PNI was associated with a 1.5% reduction in 90-day mortality (hazard ratio 0.985, 95% confidence interval 0.974\u20130.997, p = 0.012). Restricted cubic spline analysis showed an approximately linear inverse relationship between PNI and mortality risk (p for overall association = 0.046; p for nonlinearity = 0.534). Using an optimal cut-off of 29.51, patients with low PNI had significantly lower 90-day survival than those with high PNI (log-rank p &lt; 0.0001), and subgroup analyses demonstrated generally consistent protective associations across age, sex, illness severity, and key treatments. In propensity score-matched analysis, the association was attenuated and no longer significant (HR = 1.174, 95% CI: 0.901\u20131.529, p = 0.234), although the direction of effect remained consistent. Conclusions: Lower PNI at ICU admission was associated with higher 90-day mortality in multivariable-adjusted models and may serve as a simple, routinely available adjunctive marker for early risk stratification in surgical sepsis patients with AKI. However, given the non-significant finding in propensity score-matched analysis, its independent prognostic value remains uncertain, and further prospective studies are needed to validate its clinical utility.<\/jats:p>","DOI":"10.3390\/jcm15145706","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:14:27Z","timestamp":1784621667000},"page":"5706","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Nutritional Index as a Predictor of 90-Day Mortality in Surgical Sepsis Patients with Acute Kidney Injury\u2014A Retrospective Cohort Study Based on the MIMIC-IV Database"],"prefix":"10.3390","volume":"15","author":[{"given":"Jia","family":"Wan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine ICU, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China"},{"name":"Department of General ICU, The Third Affiliated Hospital of Sun Yat-sen University Zhaoqing Hospital, Zhaoqing 526070, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoqun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General ICU, The Third Affiliated Hospital of Sun Yat-sen University Zhaoqing Hospital, Zhaoqing 526070, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuncan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of General ICU, The Third Affiliated Hospital of Sun Yat-sen University Zhaoqing Hospital, Zhaoqing 526070, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiehua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine ICU, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China"},{"name":"Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University Zhaoqing Hospital, Zhaoqing 526070, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolong","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China"},{"name":"Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University Zhaoqing Hospital, Zhaoqing 526070, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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. 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