Chen Caizhen, Zhang Xiuguo, Li Baoli, Geng Qian
Department of Nursing, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
PLoS One. 2025 Aug 18;20(8):e0329616. doi: 10.1371/journal.pone.0329616. eCollection 2025.
The relationship between neutrophil-to-lymphocyte ratio (NLR) and 90-day mortality in patients with pneumonia receiving glucocorticoids alone or in combination with other immunosuppressants has not been fully verified. We aimed to explore the influence of NLR on 90-day mortality in this specific population.
This study utilized the data set from the Dryad database, involving 696 participants diagnosed with pneumonia who were receiving glucocorticoids alone or in combination with other immunosuppressants. Data on demographics, vital signs, laboratory results, and comorbidities were collected to assess the link between NLR and 90-day mortality. Multivariable Cox hazard regression analyses and smooth curve fitting were employed to assess the independent association between NLR and 90-day mortality. A two-piecewise linear regression model was used to examine the nonlinear association between NLR and in-hospital mortality. Receiver-operating characteristic curves (ROC) and area under the curves (AUC) were used to assess the ability of different biomarkers to predict the 90-day mortality in patients with pneumonia.
In total, 696 patients with pneumonia were included in this study. There were 332 individuals (47.7%) aged 18-59 years and 364 (52.3%) aged 60-99 years; 52.6% were male. The 90-day mortality rate across the study population was 26.1%. A non-linear association was noted between NLR and 90-day mortality, with an inflection point at approximately 16.475. On the left side of the inflection point, the hazard ratio was 1.145(95% confidence interval [CI]: 1.091-1.2, p < 0.001). On the right side of the inflection point, the hazard ratio was 1.0057(95% CI:0.9923-1.0192; p = 0.406), reflecting a lack of statistical significance. Similar patterns were observed in subgroup analyses, with significant interaction effects noted for age and smoking status. Furthermore, the ROC curve analysis revealed that NLR was the optimal biomarker for predicting the 90-day mortality with an AUC of 0.714 (95% CI:0.670-0.757). Using 9.34 as the cutoff value of NLR, the sensitivity was 69.8%, and the specificity was 67.7%.
A nonlinear correlation between NLR and 90-day mortality was identified in pneumonia patients undergoing glucocorticoid treatment. The NLR value of 16.475 represented the optimal threshold for predicting the 90-day mortality, after exceeding the threshold,90-day mortality tended to stabilize. The findings suggest that NLR is a practical and useful biomarker for predicting the 90-day mortality in this population.
单独使用糖皮质激素或联合其他免疫抑制剂治疗的肺炎患者中，中性粒细胞与淋巴细胞比值（NLR）与90天死亡率之间的关系尚未得到充分验证。我们旨在探讨NLR对这一特定人群90天死亡率的影响。
本研究利用了Dryad数据库中的数据集，纳入了696名被诊断为肺炎且正在单独使用糖皮质激素或联合其他免疫抑制剂治疗的参与者。收集了人口统计学、生命体征、实验室检查结果和合并症的数据，以评估NLR与90天死亡率之间的联系。采用多变量Cox风险回归分析和平滑曲线拟合来评估NLR与90天死亡率之间的独立关联。使用两段式线性回归模型来检验NLR与住院死亡率之间的非线性关联。采用受试者工作特征曲线（ROC）和曲线下面积（AUC）来评估不同生物标志物预测肺炎患者90天死亡率的能力。
本研究共纳入696例肺炎患者。其中18 - 59岁的有332人（47.7%），60 - 99岁的有364人（52.3%）；男性占52.6%。研究人群的90天死亡率为26.1%。NLR与90天死亡率之间存在非线性关联，拐点约为16.475。在拐点左侧，风险比为1.145（95%置信区间[CI]：1.091 - 1.2，p < 0.001）。在拐点右侧，风险比为1.0057（95% CI：0.9923 - 1.0192；p = 0.406），无统计学意义。亚组分析中观察到类似模式，年龄和吸烟状态存在显著交互作用。此外，ROC曲线分析显示，NLR是预测90天死亡率的最佳生物标志物，AUC为0.714（95% CI：0.670 - 0.757）。以9.34作为NLR的临界值，敏感性为69.8%，特异性为67.7%。
在接受糖皮质激素治疗的肺炎患者中，NLR与90天死亡率之间存在非线性相关性。NLR值16.475是预测90天死亡率的最佳阈值，超过该阈值后，90天死亡率趋于稳定。研究结果表明，NLR是预测该人群90天死亡率的实用且有用的生物标志物。
