Retrospective evaluation of the prognostic value of neutrophil-to-lymphocyte, platelet-to-lymphocyte, CRP-to-albumin,procalcitonin-to-albumin ratios on length of stay and mortality in palliative care unit patients

Determining the relationships between mortality, length of hospital stay, and certain laboratory parameters in patients hospitalized in palliative care units is crucial for effective patient management. In this retrospective study, 269 patients who met the inclusion criteria were selected from among 616 patients hospitalized in the Palliative Care Unit of Tokat Gaziosmanpaşa University between November 11, 2022, and December 24, 2024. The patients were divided into two groups: those who died and those who survived. Demographic characteristics, length of stay, and the ratios of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), C-reactive protein-to-albumin (CAR), and procalcitonin-to-albumin (PAR) were evaluated, and significant differences between groups in terms of hospitalization duration and laboratory parameters were investigated. Among the patients, 42% were between 75 and 89 years old, and 59.5% were male. Oncological diseases accounted for 50.2% of all diagnoses. Oral intake disorder was present in 33.7% of patients, and 40.8% were admitted from the palliative care outpatient clinic. A total of 59.5% of patients were hospitalized for 15 days or longer. Comparison of demographic and clinical characteristics by mortality status revealed significant differences between respiratory system diseases, the presence of abdominal distension, and length of stay in relation to mortality (p<0.05). Mortality rates were significantly higher among patients diagnosed with respiratory system diseases (p=0.042), those presenting with abdominal distension (p=0.034), and those hospitalized for 15 days or more (p=0.016). In deceased patients, there was a statistically significant decrease in hematological parameters (RBC, HGB, HCT, PLT) and albumin levels between the first and last measurements (p<0.05). In contrast, inflammatory parameters (CRP, procalcitonin, NLR, CAR, PAR) showed a significant increase in the final measurements (p<0.05). Although increases in NLR, CAR, and PAR were observed in both groups, these changes were more pronounced among deceased patients, indicating a stronger association with mortality (p≤0.001). These findings demonstrate that laboratory parameters play an important role in predicting mortality among palliative care patients and that inflammatory markers, in particular, have prognostic value. It was determined that hospitalization duration, along with specific inflammatory and hematological parameters, may serve as prognostic indicators in palliative care patients. Regular monitoring of these markers may enhance the accuracy of clinical decision-making and contribute to improving the quality of patient care. This study highlights the importance of laboratory-based parameters in predicting mortality in palliative care and provides a foundation for future confirmatory studies with larger patient populations. Keywords: Palliative care, NLR, PLR, CAR, PAR