İlker ŞİRİN, Tuğba SANALP MENEKŞE, Sedanur ŞAFAK, Nur VAHAPOĞLU VURAL, Gülşah ÇIKRIKÇI IŞIK
Anatolian Current Medical Journal - 2026;8(1):91-96
Aims: This study aimed to evaluate the prognostic value of the urea-to-creatinine ratio (UCR) in predicting in-hospital mortality among patients diagnosed with pneumonia and to compare its performance with the neutrophil-to-lymphocyte ratio (NLR), while minimizing confounding factors by propensity score matching. Methods: This retrospective, single-center observational study included adult patients with clinically and radiologically confirmed pneumonia who presented to the emergency department between 2023 and 2025. Demographic characteristics, laboratory parameters, and clinical outcomes were obtained from the hospital's electronic medical record system. UCR and NLR were calculated using laboratory values recorded at admission. Receiver operating characteristic (ROC) curve analyses were performed both before and after 1:1 nearest-neighbor propensity score matching, which was conducted using age, troponin I, and pro-BNP as matching variables. The primary outcome was all-cause in-hospital mortality. Results: A total of 2,884 patients met the inclusion criteria. Non-survivors (n=442) showed significantly higher UCR and NLR levels compared with survivors (n=2,442; p<0.001). In the overall cohort, UCR demonstrated strong predictive performance for mortality (Area under the curve (AUC) 0.76; 95% CI: 0.735-0.785), outperforming NLR (AUC 0.62; 95% CI: 0.591-0.648). After propensity score matching (n=826), UCR maintained its discriminatory performance (AUC 0.729; 95% CI: 0.695-0.763), again outperforming NLR (AUC 0.60). The sensitivity, specificity, positive predictive value, and negative predictive value of UCR remained clinically meaningful and consistent across both the unmatched and matched analyses. Conclusion: UCR showed a moderate yet clinically relevant ability to predict in-hospital mortality among pneumonia patients and consistently outperformed NLR, both before and after adjustment for confounders. These findings suggest that UCR may serve as a useful adjunct biomarker for early risk stratification in pneumonia.
