Platelet-to-neutrophil ratio and in-hospital mortality in pneumonia patients receiving glucocorticoid therapy: a multicenter retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Pneumonia remains a leading cause of global mortality. Patients receiving glucocorticoid therapy represent a particularly vulnerable subgroup due to therapy-induced immunosuppression, which complicates diagnosis and worsens prognosis. The platelet-to-neutrophil ratio (PNR), a composite hematologic index, has shown prognostic utility in various diseases, but its value in glucocorticoid-treated pneumonia patients remains unexplored. Methods: This multicenter retrospective cohort study utilized data from 686 hospitalized pneumonia patients receiving systemic glucocorticoids, extracted from the Dryad database. The association between admission PNR and all-cause in-hospital mortality at 30 and 90 days was assessed using Cox proportional hazards models. Receiver operating characteristic curves were used to evaluate predictive performance. Results: In-hospital mortality within both 30 and 90 days decreased significantly with increasing PNR tertiles (Tertile 1 vs. Tertile 3: 37.55% vs. 9.61% for 30-day; 43.67% vs. 10.92% for 90-day). In fully adjusted models, each standard deviation increase in PNR was associated with a 50% reduction in 30-day in-hospital mortality [Hazard Ratio (HR) = 0.497, 95% CI 0.262-0.942] and a 58% reduction in 90-day in-hospital mortality (HR = 0.416, 95% CI 0.218-0.793). Compared to the lowest tertile, the highest PNR tertile was associated with a 76% lower risk of 30-day mortality (HR = 0.235, 95% CI 0.107-0.513) and an 82% lower risk of 90-day mortality (HR = 0.184, 95% CI 0.085-0.398). PNR demonstrated superior predictive ability (areas under the curve for 30-day: 0.707; 90-day: 0.713) compared to platelet or neutrophil count alone. Subgroup analysis revealed stronger associations in patients receiving high-dose glucocorticoids and those with diabetes or hypertension. Conclusion: A lower PNR at admission is independently associated with increased short-term mortality in pneumonia patients receiving glucocorticoids. PNR, as a readily available biomarker, may facilitate early risk stratification and identify high-risk patients who could benefit from more aggressive management.
Source: Frontiers in Medicine
Authors: Junxin Lin, Ruitao Chen, Shangbo Xu, Weihan Lin
Institution: Jieyang People's Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7122798390