{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:14:26Z","timestamp":1778649266915,"version":"3.51.4"},"reference-count":77,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2023A1515010443"],"award-info":[{"award-number":["2023A1515010443"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glucocorticoids are widely used in severe pneumonia but can mask clinical symptoms and traditional severity scores. The lactate dehydrogenase-to-albumin ratio (LAR) reflects the balance between tissue injury and metabolic reserve, yet its prognostic value in steroid-treated pneumonia remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter study utilized a primary cohort (n=500) and an independent external validation cohort (n=354) of pneumonia patients receiving glucocorticoid therapy. The primary endpoints were 30-day and 90-day all-cause mortality. We employed Cox regression, restricted cubic splines (RCS), and ROC analysis to evaluate LAR performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High admission LAR (\u226510.48) was identified as a potential prognostic indicator of mortality, associated with a more than twofold risk increase at 30 days (Adjusted HR 2.54; 95% CI: 1.56-4.12) and 90 days (Adjusted HR 2.44; 95% CI: 1.56-3.82). RCS analysis confirmed a non-linear risk escalation with a biological threshold of 10.22 (P non-linearity &amp;lt; 0.001). LAR demonstrated improved predictive discrimination (AUC 0.742) compared to PSI (AUC 0.700) and CURB-65 (AUC 0.654). Although the high LAR group received lower median cumulative glucocorticoid doses (3.0g vs. 5.8g; P &amp;lt; 0.001), this finding was associated with more rapid clinical progression and truncated treatment windows in high-risk patients, reflecting a survival-time-dependent exposure rather than a lack of therapeutic intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Admission LAR is a potential, easily accessible biochemical marker that provides prognostic value independent of typical inflammatory signs masked by steroids. In patients exceeding the 10.22 threshold, our findings suggest a potential efficacy bottleneck for conventional steroid dosing, highlighting a high-risk subpopulation that may require optimized early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1835934","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:49:04Z","timestamp":1778647744000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lactate dehydrogenase-to-albumin ratio as a potential prognostic indicator in glucocorticoid-treated severe pneumonia: a multicenter retrospective study with external validation"],"prefix":"10.3389","volume":"17","author":[{"given":"Jiayi","family":"Lin","sequence":"first","affiliation":[{"name":"State Key Laboratory of Respiratory Diseases, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou 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The Second School of Clinical Medicine, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danfeng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, The Second School of Clinical Medicine, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, The Second School of Clinical Medicine, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dakai","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou 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