Introduction:
The purpose of the present study was to evaluate the potential relationship of lymphocyte-to-monocyte ratio (LMR) with outcomes of septic patients at intensive care unit (ICU) admission.

Material and methods:
3087 septic patients were included in the final cohort by using the Medical Information Mart for Intensive Care (MIMIC) database. We evaluated the association of different groups of LMR_max with 28-day survival and 1-year survival via Kaplan-Meier (K-M) analysis and Cox regression analysis. Subgroups analysis of LMR_max was performed to further explore the effect of LMR_max on survival.

Results:
According to the optimal cut-off value, the cohort was divided into low-LMR_max and high-LMR_max groups. The 28-day and 1-year survival rates were 47.9% and 19.9%, respectively, in the low-LMR_max group, and 60.4% and 25.9%, respectively, in the high-LMR_max group. Univariate logistic regression and K-M analyses revealed that the 28-day and 1-year survival rates of the high-LMR_max group were higher than those of the low-LMR_max group (both p < 0.001). A subgroup analysis of LMR_max identified a significant stepwise decrease in the risk of death at 28 days and 1 year from group 1 to group 4 (LMR_max increased gradually) after adjustment for multiple variables.

Conclusions:
We report for the first time that a lower LMR_max value is independently predictive of a poor prognosis in septic patients. Therefore, as an inexpensive and readily available indicator, LMR_max may facilitate stratification of prognosis in septic patients.