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Research Snapshot Theater: Sepsis, Adult I

PIICS After Burn Injury-Related Sepsis: NLR as an Early Marker

Sunday, March 22, 2026
9:45 AM - 10:45 AM Central Time
Location: Connections Central - RST 14
  • HK

    Hannah Kieffer, MD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MS

    Michael Santarelli, MD

    Fellow in Pediatric Cardiac Intensive Care
    Duke University School of Medicine

    Disclosure information not submitted.

  • AJ

    Alvin Jeffery, PhD, RN/APN

    Assistant Professor, Department of Biomedical Informatics
    Vanderbilt University Medical Center

    Disclosure information not submitted.

  • RS

    Ryan Stark, MD

    Associate Professor of Pediatrics Critical Care Medicine
    Vanderbilt University Medical Center

    Disclosure information not submitted.

Introduction: Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is a state of immune dysregulation and is marked by lymphopenia, hypoalbuminemia, and high C-reactive protein. It predicts poor outcomes, making early risk stratification essential. Patients with burn injuries often show vital sign and lab abnormalities at baseline, complicating early determination of illness severity and risk of deterioration. We hypothesized that admission neutrophil-to-lymphocyte ratio (NLR), absolute lymphocyte count (ALC) and neutrophil count (ANC) would be associated with PIICS development in burn patients with sepsis.


Methods: A retrospective analysis of burn-injured patients was performed using data from a single institution’s de-identified database. Multivariable logistic regression and Spearman’s rank correlation, adjusting for total body surface area (TBSA) burned and inhalation injury, were performed to analyze correlations between admission lab values and outcomes. NLR discrimination was quantified by receiver operating characteristic (ROC) curve analysis (DeLong AUC) and Fisher's exact tests yielded odds ratios.


Results: A total of 960 patients admitted for burn-injures were identified. Of the 368 patients with culture-positive sepsis (38%), 186 patients met PIICS criteria (51%). In multivariable logistic regression, only the admission NLR independently predicted PIICS (OR 1.05 per unit, p = 0.022) although with modest discrimination (AUC = 0.66, p = 0.001). Patients with an NLR >10 developed PIICS in 67% of cases versus 46% of those with NLR < 10 (OR 2.43, p = 0.025). This simplified cut-off point offered 51% sensitivity and 70% specificity. A higher NLR (median 9.62) on admission was associated with >3 infections during their hospitalization compared to those who remained infection-free (median 6.33). Lastly, NLR and ANC showed a small association with an increased number of infections during hospitalization (NLR, p = 0.006; ANC, p = 0.01).


Conclusions: Our data links high admission NLR to PIICS in burn-injured patients with sepsis regardless of injury severity, proxied by burn TBSA and inhalation injury. It is a clinically accessible biomarker; including it in early triage could help identify high-risk burn patients for closer monitoring and future targeted interventions.