Abstract
Platelet count is a readily available hematological parameter that has been recognized as a potential indicator of inflammation and thrombosis. However, previous research has not examined the prognostic significance of platelet count in patients with community-acquired pneumonia (CAP) undergoing systemic glucocorticoid therapy. This study seeks to explore the correlation between admission platelet count and 30-day mortality rates among CAP patients who are under systemic glucocorticoids treatment. Data were sourced from the Dryad database. The study population included patients diagnosed with CAP who had received systemic glucocorticoids prior to hospitalization. Patients were stratified into tertiles based on their admission platelet count. We utilized multivariable Cox regression models to evaluate the independent effect of platelet count and 30-day mortality, with adjustments for potential confounding variables. Kaplan-Meier survival analysis was conducted to compare survival rates among these groups. Complementing the primary analyses, restricted cubic spline curves and subgroup analyses were implemented to appraise the association between platelet counts and 30-day mortality among diverse subgroups. Additionally, a sensitivity analysis was performed to substantiate the robustness of our findings. A total of 614 CAP patients were included in the study. The 30-day mortality rate was 21.3% (131/614). Platelet count exhibited a significant association with mortality. Multivariable Cox regression analysis indicated that higher platelet count was independently associated with reduced 30-day mortality (HR: 0.94, 95% CI: 0.92–0.97, P < 0.001), indicating that each per 10 × 109/L rise in platelet count was associated with a 6% reduce in mortality risk. This association remained significant after adjusting for potential confounders (HR: 0.96, 95% CI: 0.94–0.99, P = 0.002). Patients in tertile 2 demonstrated a non-significant trend toward reduced mortality (HR 0.60, 95% CI: 0.35–1.02, P = 0.061), whereas those in tertile 3 showed a significantly lower risks of 30-day mortality compared to tertile 1 (HR 0.51, 95% CI: 0.31–0.86, P = 0.012). Kaplan-Meier survival curves showed that patients in the highest platelet count tertile had the highest survival rates (log-rank test: P < 0.001). Subgroup analyses revealed consistent results across different subgroups. Platelet count was inversely linearly associated with 30-day mortality. Higher platelet count on admission is significantly associated with reduced 30-day mortality in CAP patients receiving systemic glucocorticoids. This finding suggests that platelet count could serve as a potential prognostic marker for early risk stratification and clinical decision-making in this patient population.
Data availability
The datasets presented in this study can be found in online repositories (https://datadryad.org/dataset/doi:https://doi.org/10.5061/dryad.mkkwh70x2).
References
Aliberti, S., Cruz, C. S. D., Amati, F., Sotgiu, G. & Restrepo, M. I. Community-acquired pneumonia. Lancet 398, 906–919 (2021).
Torres, A. et al. Pneumonia. Nat. Rev. Dis. Primers 7, 25 (2021).
Zandman-Goddard, G. & Shoenfeld, Y. SLE and infections. Clin. Rev. Allergy Immunol. 25, 29–40 (2003).
Matteo, A. D., Bathon, J. M. & Emery, P. Rheumatoid arthritis. Lancet 402, 2019–2033 (2023).
Schols, A. M. et al. Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids. Eur. Respir J. 17, 337–342 (2001).
van den Broek, M., Smeets, B., Schreuder, M. F. & Jansen, J. The podocyte as a direct target of glucocorticoids in nephrotic syndrome. Nephrol. Dial Transpl. 37, 1808–1815 (2022).
Lv, J. et al. Perkovic V, null. Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial. JAMA 327, 1888–1898 (2022).
Kang, M. & Cavallazzi, R. Pulmonary Immunocompromise in Chronic and High-dose Steroid Therapy. Clin. Chest Med. 46, 159–167 (2025).
Li, L. et al. Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study. BMJ Open. 10, e037419 (2020).
Agustí, C. et al. Pulmonary infiltrates in patients receiving long-term glucocorticoid treatment: etiology, prognostic factors, and associated inflammatory response. Chest 123, 488–498 (2003).
Müller-Plathe, M. et al. Validation of risk scores for prediction of severe pneumonia in kidney transplant recipients hospitalized with community-acquired pneumonia. Infection 52, 447–459 (2024).
Parikh, F. Infections and Thrombocytopenia. J. Assoc. Physicians India. 64, 11–12 (2016).
Morrell, C. N., Aggrey, A. A., Chapman, L. M. & Modjeski, K. L. Emerging roles for platelets as immune and inflammatory cells. Blood 123, 2759–2767 (2014).
Thomas, M. R. & Storey, R. F. The role of platelets in inflammation. Thromb. Haemost. 114, 449–458 (2015).
Fawzy, A. et al. N. Association of platelet count with all-cause mortality and risk of cardiovascular and respiratory morbidity in stable COPD. Respir Res. 20, 86 (2019).
Yang, Q., Gao, J., Zeng, X., Chen, J. & Wen, D. Relationship Between Platelet Count and In-hospital Mortality in Adult Patients With COVID-19: A Retrospective Cohort Study. Front. Med. (Lausanne). 9, 802412 (2022).
Huang, Y., Ao, T., Zhen, P. & Hu, M. Non-linear relationship between platelet count and 28-day mortality in critically ill patients with infective endocarditis: a retrospective cohort study from MIMIC IV database. Front. Cardiovasc. Med. 11, 1458238 (2024).
Wang, L., Liu, R., Zhou, P., Hu, H. & Deng, Z. Nonlinear relationship between platelet count and 30-day in-hospital mortality in intensive care unit stroke patients: a multicenter retrospective cohort study. Front. Neurol. 15, 1374159 (2024).
Song, P. S. et al. Seong I, null. Association of baseline platelet count with all-cause mortality after acute myocardial infarction. Eur. Heart J. Acute Cardiovasc. Care. 10, 176–183 (2021).
Wang, J., Zhou, P., Li, X., Zhou, L. & Deng, Z. Association between platelet count and 30-day in-hospital mortality among intensive care unit patients with sepsis: a multicenter retrospective cohort study. Front. Med. (Lausanne). 11, 1444481 (2024).
Zhou, P. et al. Nonlinear relationship between platelet count and 30-day in-hospital mortality in ICU acute respiratory failure patients: a multicenter retrospective cohort study. Eur. J. Med. Res. 29, 312 (2024).
Metlay, J. P. et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am. J. Respir Crit. Care Med. 200, e45–45e67 (2019).
El-Menyar, A., Naduvilekandy, M., Asim, M., Rizoli, S. & Al-Thani, H. Machine learning models predict triage levels, massive transfusion protocol activation, and mortality in trauma utilizing patients hemodynamics on admission. Comput. Biol. Med. 179, 108880 (2024).
Xiang, T. et al. Platelet parameters as potential biomarkers for sepsis: a systematic review and meta-analysis. Syst. Rev. 14, 222 (2025).
Giannakeas, V. et al. Analysis of Platelet Count and New Cancer Diagnosis Over a 10-Year Period. JAMA Netw. Open. 5, e2141633 (2022).
Cato, L. D. et al. Platelet count: A predictor of sepsis and mortality in severe burns. Burns 44, 288–297 (2018).
Mirsaeidi, M. et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest 137, 416–420 (2010).
Moulis, G., Christiansen, C. F., Darvalics, B., Andersen, I. T. & Nørgaard, M. Platelet Count within the Normal Range at Hospital Admission is Associated with Mortality in Patients with Community-Acquired Pneumonia. Clin. Epidemiol. 12, 711–716 (2020).
Gorelik, O. et al. Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia. Platelets 28, 380–386 (2017).
Chen, Y., Yang, Y., Cheng, J., Lu, J. & Hu, W. Platelet count and mortality of H7N9 infected patients in Guangdong. China Platelets. 31, 268–271 (2020).
Wang, D. et al. Association Between Platelet Levels and 28-Day Mortality in Patients With Sepsis: A Retrospective Analysis of a Large Clinical Database MIMIC-IV. Front. Med. (Lausanne). 9, 833996 (2022).
Prina, E. et al. Thrombocytosis is a marker of poor outcome in community-acquired pneumonia. Chest 143, 767–775 (2013).
Grodzielski, M. & Cidlowski, J. A. Glucocorticoids regulate thrombopoiesis by remodeling the megakaryocyte transcriptome. J. Thromb. Haemost. 21, 3207–3223 (2023).
Kim, S., Chaudhary, P. K. & Kim, S. Role of Prednisolone in Platelet Activation by Inhibiting TxA(2) Generation through the Regulation of cPLA(2) Phosphorylation. Anim. (Basel). 13, 1299 (2023).
Almskog, LM. & Ågren, A. Thromboinflammation vs. immunothrombosis: strategies for overcoming anticoagulant resistance in COVID-19 and other hyperinflammatory diseases. Is ROTEM helpful or not. Front. Immunol. 16, 1599639 (2025).
Ławkowska, K., Bonowicz, K., Jerka, D., Bai, Y. & Gagat, M. Integrins in Cardiovascular Health and Disease: Molecular Mechanisms and Therapeutic Opportunities. Biomolecules. 15. (2025).
Acknowledgements
We gratefully thank Dr. Jie Liu of Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital & Physician-Scientist Center of China for his contribution to the statistical support.
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Conceptualization: Congfeng Li.Data curation: Congfeng Li.Formal analysis: Congfeng Li, Ting Ao, Yingxiu Huang.Software: Congfeng Li, Ting Ao, Yingxiu Huang.Writing original draft: Congfeng Li.Writing – review & editing: Congfeng Li, Lin Ding, Jinxiang Wang.
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The Ethics Committee of ChinaJapan Friendship Hospital (No.2015-86) granted approval for this retrospective study and orchestrated centralized collaboration and approval of all participating institutions, including anonymized data submission and collection.
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Li, C., Ao, T., Huang, Y. et al. Association between platelet count and 30-day mortality in community-acquired pneumonia patients receiving systemic glucocorticoids therapy. Sci Rep (2026). https://doi.org/10.1038/s41598-026-46565-z
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DOI: https://doi.org/10.1038/s41598-026-46565-z
