ArticleBMC gastroenterology2026
Log-transformed systemic inflammation response index improves prediction of 28-day ICU mortality in critically ill patients with cirrhosis and atrial fibrillation: development in MIMIC-IV and external validation in eICU-CRD.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundShort-term mortality is high among critically ill patients with cirrhosis and atrial fibrillation (AF). Existing scores such as SOFA, MELD-Na, and CHA₂DS₂-VASc do not directly reflect systemic inflammation. We investigated whether blood count-derived inflammatory indices could improve prediction of 28-day ICU mortality in this high-risk population.
methodsAdult ICU patients with cirrhosis and AF were identified from MIMIC-IV v3.1 (single-center development cohort) and eICU-CRD v2.0 (multicenter external validation cohort). Five inflammatory indices, including SIRI, log-SIRI, SII, log-SII, and NLR, were compared by adding each marker to a base model of age, sex, SOFA, and MELD-Na. The final model was developed using multivariable logistic regression. Internal validation used 1000-resample bootstrap, and performance was assessed by discrimination, calibration, reclassification, and decision curve analysis.
resultsA total of 454 patients from MIMIC-IV and 121 from eICU-CRD were included. The 28-day ICU mortality rates were 19.6% and 16.5%, respectively. Among the five candidate markers, SII achieved the highest AUC (0.758) and lowest AIC, but its per-unit odds ratio (1.0001) made point-based nomogram construction impractical. log-SIRI was selected for its interpretable per-unit odds ratio (1.48) and near-identical discrimination to SII (ΔAUC - 0.007), together with the biological argument that its three-lineage formulation avoids platelet count, which is unreliable in cirrhosis. Adding log-SIRI to the base model increased the AUC from 0.721 to 0.751 (ΔAUC + 0.030, DeLong P = 0.026) and improved model fit on likelihood ratio testing (χ² = 9.18, P = 0.002), with concordant improvement in continuous NRI (0.241, P = 0.037) and calibration (Hosmer-Lemeshow P 0.002 to 0.729). The optimism-corrected C-index was 0.734. External validation in eICU-CRD yielded an AUC of 0.818.
conclusionLog-SIRI was associated with 28-day ICU mortality after adjustment for age, sex, SOFA, and MELD-Na. The improvement in AUC over the base clinical model was modest but statistically significant, corroborated by concordant improvements in likelihood ratio, continuous NRI, and calibration. Prospective external calibration is needed before individual clinical use.
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