Dynamic inflammatory trajectories and 28-day mortality in patients in the intensive care unit: An exploratory observational study

Background: Inflammatory dynamics profoundly influence outcomes in critically ill patients; however, the prognostic significance of early inflammatory trajectories remains unclear. This study aimed to characterize the distinct trajectories of inflammatory mediators and evaluate their association with 28-day hospital mortality in patients in the intensive care unit (ICU). Methods: =ln[mediator + 1] for standardization). Multivariable Cox regression, inverse probability weighting, and treatment interaction analyses were performed to assess mortality risk and therapeutic responses across trajectories. Results: =0.031), whereas vasopressors and ulinastatin showed no trajectory-specific benefits. Conclusions: Early inflammatory trajectories robustly predict ICU mortality, with sustained hyperinflammation (Traj. 3) conferring the highest risk. Dynamic biomarker profiling may facilitate the development of targeted immunomodulatory strategies in high-risk subgroups.