Association between neutrophil-to-lymphocyte ratio and 30-day mortality in patients with pneumonia receiving glucocorticoid therapy

Background: The neutrophil-to-lymphocyte ratio (NLR) is a recognized prognostic marker in infectious and inflammatory diseases; however, its value for short-term mortality in pneumonia patients receiving glucocorticoid therapy remains unclear. This study evaluated the predictive role of admission NLR for 30-day all-cause mortality in this population. Methods: We conducted a retrospective cohort study using data from 696 hospitalized patients with pneumonia who received glucocorticoids, obtained from the Dryad database (Li et al.). Demographics, comorbidities, laboratory results, and corticosteroid use were collected. Prognostic effects of NLR were assessed with multivariate Cox regression, restricted cubic splines (RCS), Kaplan–Meier survival analysis, and subgroup and sensitivity analyses. Results: After multivariable adjustment, log₂ NLR was significantly associated with 30-day mortality (HR = 1.20, 95% CI: 1.06–1.35). Patients with NLR ≥ 10 had a 69% higher mortality risk compared with those with NLR < 10 (HR = 1.69, 95% CI: 1.19–2.40). RCS analysis demonstrated a linear association between NLR and mortality. Subgroup and sensitivity analyses confirmed the robustness of these findings. Conclusion: Admission NLR is an independent prognostic indicator for pneumonia patients receiving glucocorticoid therapy, particularly in those with NLR ≥ 10 who are at substantially higher risk.