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Published on: March 25, 2016
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Association Between Elevated Neutrophil-to-Lymphocyte Ratio and Mortality Risk in Community-Acquired Pneumonia: A
Zubair Ahmad Ganaie1, Yousef Aqel2, Bsher Almaalouli3
1Internal Medicine, Medicity Hospital, New Delhi, IND.
Cureus
|October 28, 2025
Summary
Elevated neutrophil-to-lymphocyte ratio (NLR) in community-acquired pneumonia (CAP) patients is linked to a doubled mortality risk. This biomarker can aid in predicting CAP patient outcomes and ICU admission.
Area of Science:
- Clinical Medicine
- Inflammation Research
- Biomarker Discovery
Background:
- The neutrophil-to-lymphocyte ratio (NLR) is a readily available biomarker reflecting systemic inflammation.
- Its prognostic value in community-acquired pneumonia (CAP) requires further elucidation.
Purpose of the Study:
- To systematically review and meta-analyze the association between elevated NLR and mortality risk in CAP patients.
- To assess NLR's predictive capability for intensive care unit (ICU) admission in CAP.
Main Methods:
- A systematic literature search was conducted across multiple databases (January 2011–August 2025).
- Twelve observational studies involving adult CAP patients were included in a random-effects meta-analysis.
- Relative risk (RR) was the primary effect measure, with quality assessed using the Newcastle-Ottawa Scale.
Main Results:
- Elevated NLR was significantly associated with increased all-cause mortality in CAP patients (RR: 2.02, 95% CI: 1.18–3.47).
- High NLR was also linked to a higher risk of ICU admission (RR: 1.30, 95% CI: 1.11–1.53).
- Substantial heterogeneity was noted across studies, indicating variability in patient populations and methodologies.
Conclusions:
- NLR is a valuable and cost-effective prognostic biomarker for predicting mortality in CAP.
- Integrating NLR into clinical assessments may improve decision-making for CAP patients.
- Further research should explore standardized NLR cutoffs and their clinical utility.
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