• Yogesh Sharma, Campbell Thompson, Angelo Zinellu, Rashmi Shahi, Chris Horwood, and Arduino A Mangoni.
• Senior Consultant Physician, Department of Acute and General Medicine, Flinders Medical Centre, Adelaide, South Australia; College of Medicine & Public Health, Flinders University, Adelaide, South Australia. Electronic address: Yogesh.Sharma@sa.gov.au.
• Clin Med (Lond). 2024 Dec 11: 100278100278.

ObjectivesThe value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in CAP patients.MethodsData from CAP admissions at two Australian hospitals from 2018 to 2023 were analysed. NLR was calculated using admission neutrophil and lymphocyte counts. Patients were categorised into NLR >12 and NLR ≤12. Multilevel-multivariable regression models, adjusting for age, sex, Charlson index, CURB-65 score, Hospital-Frailty-Risk-Score (HFRS), and C-reactive protein (CRP), assessed outcomes including length-of-stay (LOS), Intensive Care Unit (ICU) admission, and in-hospital mortality.ResultsOver six years, 7,862 CAP cases were hospitalised (mean age 75.1 years, 54.6% male). Mean NLR was 12.6, with 2,877 (36.6%) patients having an NLR >12. Those with NLR >12 were older males with higher disease severity and Charlson index (p<0.05). Adjusted analyses showed that NLR >12 was independently associated with prolonged LOS (IRR=1.11, 95% CI 1.08-1.13, p<0.001), increased risk of ICU admission (aOR=1.41, 95% CI 1.06-1.88, p=0.019), and higher in-hospital mortality (aOR=1.27, 95% CI 1.06-1.53, p=0.009). The predictive ability of the CURB-65 score for in-hospital mortality was good (AUC 0.68, 95% CI 0.66-0.70), while it was modest for the NLR (AUC 0.58, 95% CI 0.56-0.60). Incorporation of NLR to the CURB-65 score did not enhance its predictive ability (AUC 0.69, p>0.05).ConclusionsNLR independently predicts adverse outcomes in hospitalised CAP patients but does not improve the predictive performance of the CURB-65 score.Copyright © 2024. Published by Elsevier Ltd.

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