Association of early neutrophil-to-lymphocyte ratio trajectories with cardiac recovery and live ICU discharge in patients with sepsis-induced cardiomyopathy: a retrospective cohort study

BackgroundSepsis-induced cardiomyopathy (SIC) is characterized by potentially reversible myocardial dysfunction accompanied by a profound systemic inflammatory response. However, the prognostic significance of early dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) in patients with SIC remains unclear. This study aimed to identify distinct early NLR trajectories and examine their associations with cardiac recovery and live discharge from the intensive care unit (ICU).MethodsThis single-center retrospective cohort study included patients with SIC admitted to the Department of Critical Care Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine. NLR values were collected at ICU admission and at 24, 48, and 72 h thereafter. Latent class mixed modeling was used to identify distinct 72-h NLR trajectories. A 72-h landmark design was applied. The primary outcome was live ICU discharge within 28 days, with ICU death treated as a competing event and analyzed using Fine–Gray regression. The secondary outcome was cardiac recovery by days 5–7, defined as a follow-up left ventricular ejection fraction (LVEF) of ≥50% or an absolute increase of ≥10 percentage points from baseline. Multivariable logistic regression was used to evaluate the association between NLR trajectories and cardiac recovery.ResultsA total of 510 patients contributed 2,040 longitudinal NLR measurements. Three distinct trajectories were identified: low-stable (n = 230, 45.1%), high-decreasing (n = 170, 33.3%), and persistent-high (n = 110, 21.6%). The geometric mean NLR changed from 7.85 to 6.16, from 18.47 to 8.01, and from 14.95 to 22.87, respectively, during the first 72 h. Live ICU discharge occurred in 85.7%, 67.1%, and 36.4% of patients in the three groups, respectively. Compared with the low-stable group, the adjusted subdistribution hazard ratios for live ICU discharge were 0.49 [95% confidence interval (CI), 0.38–0.63; P < 0.001] for the high-decreasing group and 0.25 (95% CI, 0.17–0.37; P < 0.001) for the persistent-high group. Cardiac recovery occurred in 80.4%, 61.8%, and 42.7% of patients, respectively. The corresponding adjusted odds ratios were 0.48 (95% CI, 0.29–0.79; P = 0.004) and 0.27 (95% CI, 0.14–0.51; P < 0.001). Associations with live ICU discharge were consistent across predefined subgroups. Septic shock showed an exploratory interaction with the association between NLR trajectories and cardiac recovery (P for interaction=0.034). Sensitivity analyses yielded similar results.ConclusionsEarly 72-h NLR trajectories were independently associated with cardiac recovery and live ICU discharge in patients with SIC. A persistent-high trajectory identified patients with the poorest prognosis, whereas a high-decreasing trajectory was associated with intermediate outcomes. Serial assessment of NLR may provide a simple and clinically accessible tool for early risk stratification in SIC, although prospective external validation is warranted.