Differential expression of plasma cytokines in sepsis patients and their clinical implications.

BACKGROUND Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. According to sepsis - 3 criteria, sepsis is diagnosed by Sequential organ failure assessment (SOFA) score of more than two. Surviving sepsis campaign introduced a newer scoring system, quick SOFA (QSOFA) score which uses only clinical parameters to prognosticate sepsis bed side and at the earliest. The purpose of this study was to evaluate the QSOFA score and then compare it to SOFA score in prognostication of sepsis. METHODS This study was a prospective observational study conducted in R. L. Jalappa Hospital among 150 individuals. Assessment of SOFA and QSOFA score was done and its significance in predicting mortality and morbidity was compared. RESULTS There were 87 males and 63 females. Mortality rate was 38.7 %. The initial QSOFA score of 1, 2 and 3 had mortality rate of 5.2 %, 24.1 % and 70.7 % respectively. Initial SOFA score of < 4, 4 - 8 and > 8 had mortality rate of 5.2 %, 37.9 % and 56.9 % respectively. Interpretation - The SOFA score had statistically significant correlation in assessing need for ventilator support, QSOFA score had a significant relation assessing need for ventilator support, vasopressor support. CONCLUSIONS Both scores demonstrated good accuracy for predicting in-hospital mortality. The QSOFA scoring system can aid where the resources are limited. KEY WORDS Sepsis, SOFA Score, QSOFA Score, Septic Shock

To investigate the changes of neutrophil extracellular traps (NETs) level in plasma of sepsis patients and judge its clinical value for early diagnosing of sepsis. A prospective observational study was conducted. The patients after surgery aged > 18 years and expected to stay in the ICU > 24 hours admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from November 2014 to February 2015 were enrolled. According to the criteria of sepsis diagnosis in 1991, patients were divided into non-sepsis group and sepsis group. The healthy people who taken a physical examination were enrolled in the healthy control group. 3 mL peripheral venous blood was collected at 1 hour after admission to ICU. A fasting blood was collected in the healthy control group in the morning. The plasma free DNA (cf-DNA/NETs) was determined by using the fluorescence microplate reader, white blood cell (WBC), neutrophil ratio (NEU), procalcitonin (PCT), C-reactive protein (CRP) in peripheral blood of the patients were detected, and acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated. The correlation between plasma NETs and the risk factors in sepsis patients was analyzed by Spearman correlation analysis. The value of cf-DNA/NETs and WBC level in the diagnosis of sepsis was analyzed by using the receiver operating characteristic curve (ROC). Twenty-three sepsis patients, 20 non-sepsis patients, and 22 healthy persons were enrolled. There were no differences in baseline variables including gender and age among three groups, which indicated baseline data equalization. The plasma concentration of cf-DNA/NETs in sepsis group was significantly higher than that in non-sepsis group and healthy control group (μg/L: 453.44±185.37 vs. 188.35±29.66, 203.83±43.25, both P < 0.05), and there was no significant difference between last two groups (P > 0.05). WBC, NEU, PCT, CRP, APACHE II and SOFA score in sepsis group were significantly higher than those of non-sepsis group [WBC (×109/L): 9.52±5.51 vs. 5.97±2.28, NEU: 0.787±0.110 vs. 0.655±0.067, PCT (mg/L): 7.14 (3.60, 13.29) vs. 6.07 (3.57, 7.91), CRP (mg/L): 64.44±13.14 vs. 27.00±19.47, APACHE II: 10.25±4.92 vs. 6.00±1.22, SOFA: 6.0±5.1 vs. 5.0±1.2, all P < 0.05]. Correlation analysis showed that the level of NETs had no obvious correlation with gender, age, WBC, NEU, PCT, CRP, APACHE II and SOFA scores (r value was 0.322, 0.262, 0.194, 0.312, 0.227, 0.454, 0.433, 0.333, respectively, all P > 0.05). The area under the ROC curve (AUC) of plasma cf-DNA/NETs for the diagnosis of sepsis was 0.981. When the cut-off value of plasma cf-DNA/NETs was > 257.96 μg/L, the sensitivity was 91.3%, specialty was 95.2%, and Youden index was 0.865. AUC of WBC in the diagnosis of sepsis was 0.663. When the cut-off value of WBC was > 6.0×109/L, the sensitivity was 78.3% and specificity was 25.0%. The plasma cf-DNA/NETs levels increased significantly in sepsis patients. In the diagnosis of sepsis, plasma NETs levels had better advantages over WBC. NETs can be used as a biomarker for early diagnosis of sepsis.

There are no satisfactory diagnostic biomarkers for sepsis. Accordingly, this study screened biomarkers valuable for sepsis diagnosis and prognosis using data-independent acquisition (DIA) combined with clinical data analysis. Serine protease inhibitor Kazal-type 1 (SPINK1) is a differentially expressed protein that was screened using DIA and bioinformatics in sepsis patients (n = 22) and healthy controls (n = 10). The plasma SPINK1 levels were detected using an enzyme-linked immunosorbent assay (ELISA) in an expanded population (sepsis patients, n = 52; healthy controls, n = 10). The diagnostic value of SPINK1 in sepsis was evaluated using receiver operating characteristic (ROC) curve analysis based on clinical data. The prognostic value of SPINK1 for sepsis was evaluated using correlation and survival analyses. DIA quality control identified 78 differential proteins (72 upregulated and six downregulated), among which SPINK1 was highly expressed in sepsis. The ELISA results suggested that SPINK1 expression was significantly elevated in the sepsis group (P < 0.05). ROC analysis of SPINK1 yielded an area under the curve (AUC) of 0.9096. Combining SPINK1 with procalcitonin (PCT) for ROC analysis yielded an AUC of 1. SPINK1 expression was positively correlated with the Sequential Organ Failure Assessment (SOFA) score (r = 3497, P = 0.0053) and APACHE II score (r = 3223, P = 0.0106). High plasma SPINK1 protein expression was negatively correlated with the 28-day survival rate of patients with sepsis (P = 0.0149). The plasma of sepsis patients contained increased SPINK1 protein expression. Combining SPINK1 with PCT might have a high diagnostic value for sepsis. SPINK1 was associated with the SOFA score, APACHE II score, and the 28-day survival rate in patients with sepsis.

Background: There are an estimated 31.5 million cases of sepsis per year, and approximately 61% end up in sepsis shock, with a potential mortality rate of 5.3 million per year. In addition to the sequential organ failure assessment (SOFA) score, several biomarkers have been used to assess severity and predict mortality, including red cell distribution width (RDW). RDW is increased in conditions of ineffective red blood cell production or destruction that occur in inflammation or infection. RDW above 15.5% is associated with rigid and indestructible red blood cells, which can impede microcirculation and contribute to organ dysfunction, a part of the SOFA score.Objective: The aim of this study was to determine the correlation between RDW and SOFA score in sepsis patients admitted to the intensive care unit (ICU) of Rumah Sakit Umum Pusat Haji Adam Malik Medan.Methods: This study used a cohort-prospective study design with a consecutive sampling technique of the population that met the inclusion criteria. The samples were sepsis patients who were admitted to the ICU of Rumah Sakit Umum Pusat Haji Adam Malik Medan in April–June 2023. The data was analyzed by a Pearson or Spearman analysis test.Result: There was a significant correlation between RDW and SOFA score (r = 0.471; p&lt;0.05) in ICU sepsis patients. There was a significant correlation (p = 0.003) between RDW values and SOFA scores on the third day, where there was a moderate degree of correlation (r = 0.471), but there was no significant correlation (p = 0.103) between RDW values and SOFA scores on the first day. The sensitivity, specificity, and cut-off values of RDW were found to be 76.5%, 75%, and 14.75%, which compared to SOFA were 76.5%, 75%, and 10.5.Conclusion: There is a statistically significant relationship between RDW and SOFA, with a moderate correlation.

ObjectiveThe present study aimed to investigate the potential value of long non‐coding RNA metastasis‐associated lung adenocarcinoma transcript 1 (lnc‐MALAT1)/microRNA (miR)‐125a axis in disease management and prognosis surveillance of sepsis.MethodsTotally, 196 sepsis patients and 196 healthy controls were enrolled. Blood samples were collected within 24 hours after admission in sepsis patients and were collected at enrollment in healthy controls. The relative expression of lnc‐MALAT1 and miR‐125a in all participants was detected by reverse transcription quantitative polymerase chain reaction, and the inflammatory cytokines in plasma of sepsis patients were measured by enzyme‐linked immunosorbent assay.ResultsLnc‐MALAT1/miR‐125a axis was increased in sepsis patients compared with healthy controls (P < .001) and was of excellent value in distinguishing septic patients from healthy controls with the area under the curve (AUC) of 0.931 (95% CI: 0.908‐0.954). In sepsis patients, lnc‐MALAT1 was negatively associated with miR‐125a, and lnc‐MALAT1/miR‐125a axis was positively correlated with acute pathologic and chronic health evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, serum creatinine, C‐reactive protein, tumor necrosis factor‐α, interleukin (IL)‐1β, IL‐6, and IL‐8, while negatively associated with albumin. Furthermore, lnc‐MALAT1/miR‐125a axis was of value in predicting increased 28‐day mortality risk to some extent (AUC: 0.678, 95% CI: 0.603‐0.754).ConclusionLnc‐MALAT1/miR‐125a axis presents excellent value in differentiating sepsis patients from healthy controls and also exhibits positive association with general disease severity, organ injury, inflammation level, and mortality in sepsis patients.

The aim is to examine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with major burns and sepsis. We collected the data of major burn patients who were admitted to our department. We compared the age, sex, burn area, burn depth, length of hospitalization, and mortality rate between the sepsis group and non-sepsis group and compared NT-proBNP, procalcitonin (PCT), platelet count, Sequential Organ Failure Assessment (SOFA) score, and quick SOFA (qSOFA) score between the survivors and nonsurvivors in the sepsis group. Receiver operating characteristic (ROC) curves were used in sepsis patients to evaluate the prognostic value of NT-proBNP, PCT, SOFA score, qSOFA score, etc. Kaplan-Meier survival curves were used to compare the 90-day survival curves of patients. Logistic regression analysis was used to analyze the risk factors that affect the prognosis of sepsis patients. There were 90 major burn patients with sepsis and 114 major burn patients without sepsis. The mortality rate for the major burn sepsis group was significantly higher than that for the non-sepsis group. The NT-proBNP level in sepsis patients in the nonsurvivor group was 2900 pg/ml, which was significantly higher than that in patients in the survivor group. Survival analysis showed that the mean survival time for the NT-proBNP &gt;2000 pg/ml group was 15.08 days. Multivariate regression analysis indicated that NT-proBNP was an independent risk factor for mortality in burn patients with sepsis. NT-proBNP can be used as a prognostic marker in patients with major burns and sepsis.

Aim: Thymosin alpha 1 (Tα1) is a promising treatment for the improvement of sepsis patients. Until now, its function in reducing acute organ damage of sepsis patients is still unclear. The aim of this study was to determine whether Tα1 can alleviate organ dysfunction in sepsis patients. Methods: This study retrospectively enrolled sepsis patients from a multicenter randomized controlled trial [efficacy of Tα1 for severe sepsis (ETASS)]. The sequential organ failure assessment (SOFA) score on day 0 (initial), day 3, and day 7 was collected. Absolute SOFAday07 was defined as initial SOFA score minus SOFA score on day 7 (initial SOFA–SOFA day7). Delta SOFA score (ΔSOFAday07) was provided by the formula: (initial SOFA–SOFA day7) × 100/initial SOFA, and it was expressed as a percentage. After propensity score matching (1:1 ratio), baseline characteristics were well-balanced between the Tα1 group and placebo group. The primary outcome was evaluated with a comparison of ΔSOFAday07 decline between patients treated with or without Tα1 therapy. Results: Among 288 enrolled patients, 149 patients received both Tα1 and standard therapy (Tα1 group), and 139 patients received both placebo and standard therapy (placebo group). Compared with the placebo group, the Tα1 group had significantly lower Absolute SOFAday07 [95% confidence interval (CI) 0.8 (0–1.7), P = 0.049]. Among 111 pairs of patients matched by propensity score, the Tα1 group still had lower Absolute SOFAday07 [95% CI 1.0 (0.1–1.9), P = 0.029]. Meanwhile, Tα1 treatment could significantly improve ΔSOFAday07. When the amplitude of ΔSOFAday07 was graded, one third of patients in the Tα1 group had an increase of more than 60%, compared with 22% in the placebo group. Subgroup analysis found that the ΔSOFAday07 improved significantly after Tα1 therapy in sepsis patients with no immunoparalysis at baseline, no complications, and early intervention. Conclusions: For sepsis patients, Tα1 treatment can alleviate organ dysfunction, and ΔSOFAday07 can be used as an indicator of its therapeutic effect (ClinicalTrials.gov identifier: NCT00711620).

Background/Objectives: Neutrophils, as the first line of defense in the immune response, produce neutrophil extracellular traps (NETs) upon activation, which are significant in the pathogenesis and organ damage in sepsis. This study aims to explore the clinical value of myeloperoxidase-DNA (MPO-DNA) and cell-free DNA (cf-DNA) in sepsis patients. Methods: Clinical data were collected from 106 sepsis patients, 25 non-sepsis patients, and 51 healthy controls. Sequential Organ Failure Assessment (SOFA) scores were calculated, and levels of MPO-DNA) complexes and cf-DNA were measured using specific kits. Correlation analyses assessed relationships between indicators, while logistic regression identified independent risk factors. Receiver operating characteristic (ROC) curves calculated the area under the curve (AUC) to evaluate the diagnostic value of the biomarkers. Results: Sepsis patients exhibited significantly elevated levels of MPO-DNA and cf-DNA compared to non-sepsis patients and healthy controls. In sepsis patients, MPO-DNA and cf-DNA levels correlated with inflammation, coagulation, and organ damage indicators, as well as procalcitonin (PCT) levels and SOFA scores. Both C-reactive protein (CRP) and cf-DNA were identified as independent risk factors for sepsis, demonstrating moderate diagnostic value. ROC analysis showed that the combination of MPO-DNA and CRP (AUC: 0.837) enhances the AUC value of CRP (0.777). Conclusions: In summary, elevated serum levels of MPO-DNA and cf-DNA in sepsis patients correlate with SOFA scores and PCT levels, providing reference value for sepsis diagnosis in clinical settings.

Background: The new definition of Sepsis-3 defines sepsis as life-threatening organ dysfunction, demonstrated by an increase in the Sequential Organ Failure Assessment (SOFA) of 2 or more points, caused by a dysregulated host response to infection. The performance of SOFA score data in a setting of a tertiary public hospital in a middle-income country remains limited. Objective: To determine the accuracy of the SOFA score to predict the 28-day mortality in community-acquired sepsis patients. Materials and Methods: A retrospective study enrolled community-acquired sepsis and septic shock patients admitted between January and December 2015 in Hatyai Hospital, a tertiary public Hospital in Southern Thailand. All variables for calculating the SOFA and qSOFA scores were collected. The primary outcome was the 28-day mortality. Results: Three hundred seventy-nine patients were enrolled. Eighty-seven patients (23%) died. The median (IQR) SOFA score was 6 (3, 9) points. The SOFA score had a fair predictive performance (AUROC 0.71, 95% CI 0.65 to 0.77), which was higher than qSOFA score (AUROC 0.67, 95% CI 0.62 to 0.73). The SOFA score of 2 points associated with mortality (13%) and higher score patients had an incremental increase mortality rate. The hazard ratio (HR) was 4.59 (95% Cl 1.3 to 15.78, p=0.02) for SOFA Score 6 to 7 points. Conclusion: Among patients presenting with community-acquired infection, the SOFA score indicated the fair predicting ability for the 28-day mortality and performed better than qSOFA score. Keywords: SOFA, qSOFA, Sepsis, Accuracy, Mortality, Community-acquired infection, Thailand

Introduction: Hyponatremia is a frequent electrolyte imbalance observed in critically-ill patients. The Sequential Organ Failure Assessment (SOFA) score is a tool used in sepsis management to assess the severity of organ dysfunction and predict mortality in critically-ill patients. Thus, establishing an association between hyponatremia and the SOFA score aids in triaging patients at high risk of mortality and enhancing management strategies. Aim: To estimate the prevalence of hyponatremia in sepsis patients hospitalised in the critical care unit and analyse its association with SOFA scores. Materials and Methods: The prospective observational crosssectional study was carried out at the Critical Care Unit of Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Gujarat, India over a one-month duration in November 2024 on 88 sepsis patients aged over 18 years. Following informed consent, routine investigations such as Arterial Blood Gas (ABG), serum bilirubin, platelet count, creatinine, and sodium levels were performed. SOFA scores were calculated at the time of admission, and the severity of hyponatremia was assessed. Statistical tests for prevalence and associations within the data were applied, and the Chi-square test with a p-value of less than 0.05 was considered statistically significant. Results: The mean age of study patients with hyponatremia was 50.74 years, with a standard deviation of 16.49 years. The majority of study participants were male, comprising 62.32%, while females accounted for 37.68%. Hyponatremia was observed in 78.4% of sepsis patients, with 39.8% exhibiting mild hyponatremia, 25% moderate hyponatremia, and 13.6% severe hyponatremia. A SOFA score of 2 was most frequent in 19 patients (27.5%), and the mean SOFA score was 4.42, with a standard deviation of 2.34. The three most common aetiological diagnoses for hyponatremia were lower respiratory tract infection, followed by decompensated Chronic Liver Disease (CLD) and acute ischaemic stroke with aspiration pneumonia. The association between the SOFA score and the severity of hyponatremia was statistically significant, as indicated by the Chi-square test (p&lt;0.05). Additionally, a statistically significant association was observed between the severity of hyponatremia and specific components of the SOFA score, namely platelet count and serum creatinine. Conclusion: Hyponatremia is highly prevalent in critically-ill sepsis patients. The association between hyponatremia and SOFA scores highlights the need for timely diagnosis and management of hyponatremia to reduce morbidity and mortality.

This study examines the trends of procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and sequential organ failure assessment (SOFA) scores in intensive care unit (ICU) sepsis patients from different infection sources. Elevations in PCT and NLR reflect infection severity and predict sepsis prognosis. Combining them may enhance diagnostic accuracy and prognostic capabilities, despite variations in cut-off values. The study emphasizes the significance of these biomarkers in improving sepsis management and patient outcomes. This was a prospective observation study of ICU sepsis patients from different infection sources. Procalcitonin and NLR levels were measured on days 0, 2, and 4 of admission. Sequential organ failure assessment scores on these days were also analyzed. The cut-off values were obtained for predicting the prognosis of sepsis ICU patients. The study included 100 sepsis patients with an equal distribution of males and females and a mean age of 72 years. Procalcitonin showed a significant decrease over time, while NLR initially increased before decreasing on day 4, and SOFA scores showed no significant changes. Deceased patients had significantly higher PCT and SOFA scores on days 2 and 4. Receiver operating characteristic curve analysis showed promising predictive results for PCT on day 4 and SOFA scores on days 2 and 4. Understanding the trends of PCT and NLR concerning the infection source can provide deeper insights into their diagnostic and prognostic capabilities. This comparative analysis of PCT, NLR, and SOFA score trends contributes to the improvement of patient outcomes through accurate assessment of sepsis severity and progression, early diagnosis, and timely intervention. Jayara A, Mascarenhas J, Gandhi B, Nimbolkar J. Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit. Indian J Crit Care Med 2024;28(10):942-951.

Age-adjusted Sequential Organ Failure Assessment (SOFA) and age-adjusted quick SOFA (qSOFA) scores have been developed to predict poor outcomes in children with infection. We investigated the prognostic performance of age-adjusted SOFA and age-adjusted qSOFA scores and compared them with the systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in children with infection. A bivariate random-effects regression model was used for synthesis of diagnostic test data. A total of 14 studies invoing 70,194 participants were included. The pooled sensitivity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82 (95% CI, 0.74-0.88), 0.46 (95% CI, 0.22-0.71), and 0.79 (95% CI, 0.66-0.88), respectively. The pooled specificity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.62 (95% CI, 0.45-0.77), 0.90 (95% CI, 0.66-0.98), and 0.39 (95% CI, 0.26-0.54), respectively. The area under the summary receiver operating characteristic curve (AUSROC) for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82 (95% CI, 0.79-0.85), 0.66 (95% CI, 0.62-0.70), and 0.64 (95% CI, 0.60-0.68), respectively. Different baseline populations, different SOFA adaptation methods and different cut-offs used for age-adjusted SOFA may be potential sources of heterogeneity. Age adjusted SOFA score is a useful tool for predicting mortality in children with sepsis/suspected sepsis. First study to investigate the prognostic performance of age-adjusted sequential organ failure assessment (SOFA) and age adjusted quick SOFA (qSOFA) scores in comparison to the systemic inflammatory response criteria (SIRS) for the prediction of mortality in children with sepsis. The age-adjusted SOFA score predicts poor outcomes with high sensitivity in children with sepsis Low sensitivity limits the utility of age-adjusted qSOFA as a simple predictive tool for adverse outcomes. Developing another enhanced or modified bedside tool with higher sensitivity may be necessary.

Background: The objective of the study was to assess prognostic accuracy of SOFA (sequential organ failure assessment score) and Q-SOFA (quick-sequential organ failure assessment) score in detecting morbidity and mortality in critically ill children admitted in our intensive care unit.Methods: All critically ill children admitted were recruited over a time period of 7 months. Q-SOFA score was assessed at presentation, followed by SOFA score on day 1 and day 2 of ICU stay and outcome was observed.Results: Total of 272 sick children were recruited and assessed. All eight (2.94%) mortalities had high Q-SOFA score of three (p&lt;0.001), mean SOFA (day 1) score 11.12±0.99 (p&lt;0.001), mean SOFA (day 2) was 11.62±1.40 (p&lt;0.001).Conclusions: Q-SOFA is a simple, inexpensive and rapid test to assess and predict sick children requiring ICU care in emergency department. High SOFA score predicts high probability of mortality and detects organ failure early.

BackgroundSepsis is a state of life-threatening organ dysfunction caused by a dysregulated host response to infection, leading to consecutive organ failure and lethal outcome. The purpose of this study is to assess the value of the combined use of plasma high-density lipoprotein 2b (HDL2b) level and Sequential Organ Failure Assessment (SOFA) score in predicting short-term mortality from sepsis.Materials and methodsA prospective, observational study was conducted in patients with sepsis and non-septic controls admitted to three intensive care units (ICUs) from January 2020 to December 2021. SOFA scores were recorded on the first day after admission. Blood samples were collected from each enrolled patient and the levels of HDL2b were analyzed using microfluidic chip technology. Receiver-operator characteristic curve (ROC) analyses were conducted to determine the values of plasma HDL2b level, SOFA score and the combined HDL2b levels and SOFA score (HDL2b + SOFA) in predicting the prognosis of mortality, respectively. The primary endpoint was 28-day mortality and the secondary outcome was total in-hospital mortality.ResultsCompared to non-septic controls, patients with sepsis had lower HDL2b levels (10.95% [8.95, 12.96] vs. 23.78% [14.53, 29.16], p < 0.001). Among sepsis patients, the levels of HDL2b of non-survivors were lower than those of survivors (6.74% [4.63, 8.08] vs. 11.78 [7.20, 13.40], p = 0.002). Moreover, our data also indicated that patients with higher HDL2b + SOFA scores shown higher rates of 28-day and total in-hospital mortality. The areas under the ROC curves for predicting 28-day mortality were 0.755 for HDL2b, 0.782 for SOFA, and 0.806 for HDL2b + SOFA. Multivariate analyses indicated that HDL2b + SOFA (Odd Ratio: 1.321 (95% Confidence Interval: 1.028–1.698), p = 0.029) was potential predictors of 28-day mortality.ConclusionsThe HDL2b + SOFA composite score was a reliable predictor of 28-day and in-hospital mortality in sepsis patients, showing better discriminatory ability than SOFA alone.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-025-12147-z.

Angiogenic factor with G patch and FHA domains 1 (AGGF1) is a crucial angiogenic factor that is involved in a variety of diseases and in the regulation of inflammatory responses. However, its role in sepsis is poorly understood. We have investigated the role of AGGF1 in the classification and prognostic evaluation of adult septic patients in a clinical context. A total of 126 septic patients who visited the Emergency Department of Beijing Chao-Yang Hospital and 76 non-sepsis patients visiting the Physical Examination Center of Beijing Chao-Yang Hospital were enrolled. AGGF1 levels in plasma were detected by enzyme-linked immunosorbent assay. Spearman correlation analysis was used to determine correlations between plasma AGGF1 and Sequential Organ Failure Assessment (SOFA) score, Acute Pathology and Chronic Health Evaluation II (APACHE II) score, procalcitonin and lactate. We evaluated the classification significance of AGGF1 in sepsis using receiver operating characteristic (ROC) curves. We also assessed the predictive significance of AGGF1 for 28-day mortality in sepsis using ROC curves and Kaplan-Meier analyses. Plasma AGGF1 levels were higher in sepsis patients than in non-sepsis patients (P < 0.001). Among sepsis patients, plasma AGGF1 levels were higher in non-survivors than in survivors (P < 0.001). Increased plasma AGGF1 levels were positively correlated with SOFA score, APACHE II score, procalcitonin and lactate. Plasma AGGF1 levels could distinguish sepsis patients from non-sepsis patients (area under the curve [AUC] = 0.777). AGGF1 had a higher predictive value than SOFA score, APACHE II score, lactate, procalcitonin, and white blood cell count for 28-day mortality in patients with sepsis (AUC = 0.876). Furthermore, Kaplan-Meier analysis indicated that lower plasma AGGF1 levels were associated with lower 28-day mortality compared with higher plasma AGGF1 levels (log rank P < 0.001). AGGF1 is useful for the classification and evaluating prognosis of adult septic patients.