BACKGROUND: Over-activation of the NLRP3 inflammasome can lead to sepsis. NLRP3 
is an essential protein in the classical pathway of pyroptosis. This study 
assessed the use of serum NLRP3 level as a potential inflammatory biomarker in 
septic patients.
METHODS: Patients were categorized into five groups: healthy controls (n = 30), 
ICU controls (n = 22), infection (n = 19), septic non-shock (n = 33), and septic 
shock (n = 83). Serum NLRP3 levels were measured by enzyme-linked immunosorbent 
assay for all patients upon enrollment. Clinical parameters and laboratory test 
data (APACHE II, SOFA, and lactate) were also assessed. Moreover, the ability of 
serum NLRP3 levels to predict sepsis was determined by the area under the curve 
(AUC) analysis.
RESULTS: The NLRP3 levels in the septic shock group was significantly higher 
(431.89, 386.61-460.21 pg/mL) than that in the healthy control group (23.24, 
9.38-49.73 pg/mL), ICU control group (74.82, 62.71-85.93 pg/mL), infection group 
(114.34, 99.21-122.56 pg/mL), and septic non-shock group (136.99, 
128.80-146.98 pg/mL; P＜0.001 for all comparisons). Additionally, the AUC 
indicated that the ability of serum NLRP3 levels to predict sepsis and septic 
shock incidences was not lower than that of the SOFA score. Patients with higher 
NLRP3 serum levels (>147.72 pg/mL) had significantly increased 30-day mortality 
rate.
CONCLUSIONS: NLRP3 is useful for the early identification of high-risk septic 
patients, particularly septic shock patients. Moreover, elevated NRLP3 levels 
could result in poor septic prediction outcomes.