OBJECTIVE  To analyze the predictive value of the neutrophil-to-lymphocyte-platelet ratio （N/LPR） for the disease outcome in patients with community-acquired severe pneumonia.

METHODS  A retrospective analysis was conducted on patients with community-acquired severe pneumonia admitted to Guizhou Provincial People's Hospital from Jan. 2023 to Dec. 2024. Patients were divided into a non-survivor group and a survival group based on their 28-day clinical outcomes. Data were collected on patients' sex, age, history of underlying diseases, as well as initial neutrophil count, lymphocyte count, platelet count, C-reactive protein （CRP） and N/LPR at admission. Logistic regression analysis was employed to examine the association between N/LPR and disease outcome in patients with community-acquired severe pneumonia. Receiver operating characteristic （ROC） curve analysis was conducted to evaluate the predictive performance of N/LPR for disease outcome. Kaplan-Meier survival analysis was adopted to compare the survival of patients with community-acquired severe pneumonia across different N/LPR levels.

RESULTS  The 28-day mortality among the 320 patients with severe pneumonia was 20.94% （67/320）. In the non-survival group, the use of invasive mechanical ventilation, ICU admission, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score, Sequential Organ Failure Assessment （SOFA） score, neutrophil count, N/LPR, neutrophil-to-lymphocyte ratio （NLR） and CRP were higher than those in the survival group, while the oxygenation index, lymphocyte count and platelet count were lower （P＜0.05）. Multivariate logistic regression analysis showed that N/LPR was associated with poor prognosis in patients with community-acquired severe pneumonia, with an area under the ROC curve （AUC） of 0.775 for predicting disease outcome （P＜0.05）. Kaplan-Meier survival analysis indicated that patients with N/LPR values above the cutoff had a lower 28-day survival rate compared to those with values below the cutoff （P＜0.05）.

CONCLUSIONS  N/LPR is a predictive factor for the prognosis of patients with community-acquired severe pneumonia, and is closely associated with the severity of the disease. N/LPR aids in early warning of the risk of adverse prognosis in patients with severe pneumonia.