Lactate dehydrogenase-to-albumin ratio as a potential prognostic indicator in glucocorticoid-treated severe pneumonia: a multicenter retrospective study with external validation

Category	Detail
Condition	Severe Pneumonia
Key Mechanisms	Lactate dehydrogenase-to-albumin ratio (LAR) reflects tissue injury and metabolic reserve.
Target Population	Patients with severe pneumonia receiving glucocorticoid therapy.
Care Setting	Multicenter hospitals treating severe pneumonia.

High admission LAR (≥10.48) is associated with over twofold increased risk of 30-day and 90-day mortality.
LAR shows improved predictive discrimination compared to PSI and CURB-65.
A biological threshold for LAR was identified at 10.22, indicating non-linear risk escalation.
Patients with high LAR received lower median glucocorticoid doses but had rapid clinical progression.
LAR provides prognostic value independent of traditional inflammatory signs masked by glucocorticoids.

Utilize LAR as a prognostic marker in patients with severe pneumonia on glucocorticoids.

Consider optimizing early intervention for patients exceeding the LAR threshold of 10.22.

High LAR indicates increased mortality risk and may reflect inadequate therapeutic response.

Patients hospitalized with severe pneumonia and receiving glucocorticoid therapy.

Lower glucocorticoid doses were associated with higher LAR and rapid clinical deterioration.

Incorporate LAR into routine assessments for pneumonia patients on glucocorticoids.
Be aware of the limitations of traditional severity scores in glucocorticoid-treated patients.

Clinical Scorecard: Evaluating the Lactate Dehydrogenase-to-Albumin Ratio as a Prognostic Marker in Severe Pneumonia Patients Treated with Glucocorticoids