Neutrophil‐Lymphocyte‐Monocyte Ratio in Predicting the Risk of Death in Patients With Severe Pneumonia in the Intensive Care Unit: A Single‐Center Retrospective Cohort Study

Background Severe pneumonia remains a leading cause of high mortality globally. While numerous new detection markers for pneumonia of this type have been introduced in clinical practice, their application in primary healthcare settings remains limited. The neutrophil‐to‐lymphocyte‐to‐monocyte ratio (NLMR) is a simple and easily accessible parameter. The aim of this study was to explore its potential as an early warning indicator for the prognosis of pneumonia. Methods We conducted a retrospective analysis of the first pneumonia patients admitted to the intensive care unit (ICU) from January 2019 to June 2025. We compared the 24 h scores and laboratory data of the survival group and with those of the nonsurvival group, analyzed the prognostic factors for pneumonia via multivariate logistic regression, and assessed their predictive value via receiver operating characteristic (ROC) curves. The Kaplan–Meier (K–M) method was used to estimate survival outcomes on the basis of differing ICU admission NLMR levels. Results The study included a total of 181 patients, 39 of whom died within 30 days. Compared with the survival group, the nonsurvival group presented significantly higher NLMR values upon ICU admission. The multivariate binary logistic analysis revealed that the NLMR independently contributed to an increased risk of mortality (OR = 1.013, 95% CI 1.00–1.018; p < 0.05). The NLMR exhibited an ROC‐AUC of 0.844 (95% CI, 0.768–0.921), and both the Hosmer–Lemeshow test and calibration plots indicated superior accuracy for the NLMR model. K–M analysis demonstrated that higher NLMR values at ICU admission were associated with significantly reduced 30‐day survival. Conclusion Elevated NLMR at ICU admission was an independent risk factor for increased 30‐day mortality in patients with pneumonia, especially when the NLMR was greater than 120.