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Peer-reviewedCC BYFrontiers in medicine

Neutrophil-to-lymphocyte ratio is associated with in-hospital mortality in patients with cirrhosis and pneumonia: a multicenter retrospective study

  • Hui Zhang1
  • Lixia Huang1
  • Pengpeng Sun1
  • Youling Dong2
  • Ye Gu3
  • Xian Chen4
  • Shuang Suo5
  • Meng Zhang1
  • Ye Zhang6
6 affiliations
  1. 1Department of Critical Care Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences , ,
  2. 2Department of Respiratory, Beijing Jingmei Group General Hospital , ,
  3. 3Department of Emergency, Chuiyangliu Hospital Affiliated to Tsinghua University , ,
  4. 4Department of Emergency, Chinese People’s Armed Police Force Characteristic Medical Center , ,
  5. 5Department of Respiratory and Critical Care Medicine, Beijing Mentougou District Hospital , ,
  6. 6Beijing Tongren Hospital Mentougou Campus, Capital Medical University , ,
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Abstract

Background: Patients with cirrhosis complicated by pneumonia face high in-hospital mortality, yet reliable prognostic tools remain limited. The neutrophil-to-lymphocyte ratio (NLR) is a readily available inflammatory marker with established prognostic value across various diseases. However, multicenter evidence on the independent association of log10NLR with mortality in this specific population is lacking. This study therefore investigated the association between log10NLR and in-hospital mortality in patients with cirrhosis and pneumonia, and evaluated its discriminative performance.

Methods: This multicenter study included 851 patients with cirrhosis and pneumonia from five Chinese centers (2016–2025). Admission log10NLR was the exposure and in-hospital mortality the outcome. Multivariable logistic regression with multiple imputation, restricted cubic splines, and ROC analysis was used; the incremental value of log10NLR beyond the Child-Pugh and CURB-65 scores was assessed by the DeLong test, calibration curves, and decision-curve analysis.

Results: Among 851 patients, in-hospital mortality was 14.9%. In the fully adjusted model, a 1-unit increase in log10NLR (a 10-fold increase in NLR) was associated with higher odds of in-hospital death (OR: 3.82, 95% CI: 1.97–7.38; P < 0.001). Across tertiles, the odds increased progressively (second: OR: 2.81, 95% CI: 1.44–5.47; third: OR: 3.35, 95% CI: 1.65–6.78; P for trend = 0.001), and restricted cubic spline analysis showed a linear relationship (P for overall association = 0.003; P for non-linearity = 0.431). The AUC for log10NLR was 0.707 (95% CI: 0.660–0.754), numerically higher than for Child-Pugh (0.647) and CURB-65 (0.658), though not significantly (DeLong P > 0.05). Adding log10NLR to each score significantly improved discrimination (ΔAUC = 0.090 and 0.076; both P < 0.001) and net benefit. An exploratory cutoff of approximately 5 (sensitivity 74.0%, specificity 57.6%) requires independent validation.

Conclusions: Log10NLR was independently associated with in-hospital mortality in cirrhosis with pneumonia, with a linear dose–response relationship. Its discrimination alone was comparable to the Child-Pugh and CURB-65 scores; however, adding log10NLR significantly improved discrimination (ΔAUC = 0.090 and 0.076; both P < 0.001) and net benefit, suggesting a complementary role in risk stratification.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026neutrophiltolymphocyte,
  title = {{Neutrophil-to-lymphocyte ratio is associated with in-hospital mortality in patients with cirrhosis and pneumonia: a multicenter retrospective study}},
  author = {Hui Zhang and Lixia Huang and Pengpeng Sun and Youling Dong and Ye Gu and Xian Chen and Shuang Suo and Meng Zhang and Ye Zhang},
  journal = {Frontiers in medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fmed.2026.1963013},
  url = {https://europepmc.org/article/PMC/PMC13724411},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Neutrophil-to-lymphocyte ratio is associated with in-hospital mortality in patients with cirrhosis and pneumonia: a multicenter retrospective study
AU  - Hui Zhang
AU  - Lixia Huang
AU  - Pengpeng Sun
AU  - Youling Dong
AU  - Ye Gu
AU  - Xian Chen
AU  - Shuang Suo
AU  - Meng Zhang
AU  - Ye Zhang
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in medicine
DO  - 10.3389/fmed.2026.1963013
UR  - https://europepmc.org/article/PMC/PMC13724411
AB  - Background: Patients with cirrhosis complicated by pneumonia face high in-hospital mortality, yet reliable prognostic tools remain limited. The neutrophil-to-lymphocyte ratio (NLR) is a readily available inflammatory marker with established prognostic value across various diseases. However, multicenter evidence on the independent association of log10NLR with mortality in this specific population is lacking. This study therefore investigated the association between log10NLR and in-hospital mortality in patients with cirrhosis and pneumonia, and evaluated its discriminative performance.  Methods: This multicenter study included 851 patients with cirrhosis and pneumonia from five Chinese centers (2016–2025). Admission log10NLR was the exposure and in-hospital mortality the outcome. Multivariable logistic regression with multiple imputation, restricted cubic splines, and ROC analysis was used; the incremental value of log10NLR beyond the Child-Pugh and CURB-65 scores was assessed by the DeLong test, calibration curves, and decision-curve analysis.  Results: Among 851 patients, in-hospital mortality was 14.9%. In the fully adjusted model, a 1-unit increase in log10NLR (a 10-fold increase in NLR) was associated with higher odds of in-hospital death (OR: 3.82, 95% CI: 1.97–7.38; P < 0.001). Across tertiles, the odds increased progressively (second: OR: 2.81, 95% CI: 1.44–5.47; third: OR: 3.35, 95% CI: 1.65–6.78; P for trend = 0.001), and restricted cubic spline analysis showed a linear relationship (P for overall association = 0.003; P for non-linearity = 0.431). The AUC for log10NLR was 0.707 (95% CI: 0.660–0.754), numerically higher than for Child-Pugh (0.647) and CURB-65 (0.658), though not significantly (DeLong P > 0.05). Adding log10NLR to each score significantly improved discrimination (ΔAUC = 0.090 and 0.076; both P < 0.001) and net benefit. An exploratory cutoff of approximately 5 (sensitivity 74.0%, specificity 57.6%) requires independent validation.  Conclusions: Log10NLR was independently associated with in-hospital mortality in cirrhosis with pneumonia, with a linear dose–response relationship. Its discrimination alone was comparable to the Child-Pugh and CURB-65 scores; however, adding log10NLR significantly improved discrimination (ΔAUC = 0.090 and 0.076; both P < 0.001) and net benefit, suggesting a complementary role in risk stratification.
SN  - 2296-858X
ER  -