Analisis Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), dan Systemic Immune-Inflammation Index (SII) berdasarkan Etiologi dan Derajat Keparahan Pneumonia Komunitas Akut

Abstract

Introduction. Community acquired pneumonia (CAP) has caused significant mortality and morbidity. Determining etiology often difficult, and assessing severity either with PSI in adults or WHO criteria in children were also complex. NLR, PLR, and SII have shown potential as alternatives for rapid assessment. Objective. This study aims to analyze NLR, PLR, and SII with etiology and severity of CAP in pediatric and adults. Materials & Methods. Data of inpatient admissions between August 2024 and October 2025 were collected from three hospitals in Medan City, Indonesia. Patients without sputum culture and negative PCR results were excluded. Multivariate logistic regressions was used to find association between NLR and patient characteristics with pneumonia severity. Results. 179 patients were included in the study, consisting of 37 pediatrics and 142 adults. Analyses were performed separately. In pediatric group, none of the biomarkers showed a significant correlation with pneumonia severity. In adult group, the median of NLR was significantly higher in severe pneumonia (p < 0.001). ROC analysis show a fair predictive performance (AUC 0.706) and an optimal cut-off of 8.99. In multivariate analysis, old age, CKD and high NLR were significant predictors of severe pneumonia, with adjusted odds ratios (AOR) of 8.877, 6.719, and 4.608 respectively. PLR and SII were not associated with severity. Across both age groups, NLR, PLR, and SII showed no significant association with pneumonia etiology. Conclusion. Higher NLR is significantly associated with more severe pneumonia in adult, suggesting its potential as a complementary or alternative to PSI score.