Higher levels of neutrophil percentage-to-albumin ratio predict increased mortality risk in patients with liver cirrhosis: a retrospective cohort study

Abstract

Background Recent studies indicated that the neutrophil percentage-to-albumin ratio (NPAR) was a predictor of mortality in several diseases. There has been no evidence to prove the predictive function of NPAR in patients with liver cirrhosis. Therefore, this study aimed to investigate the association between NPAR and clinical outcomes in cirrhotic patients. Methods We retrospectively recruited hospitalized decompensated cirrhotic patients from the tertiary grade-A hospital. Patients with malignancy or severe cardiac, respiratory and kidney diseases were excluded. Demographical data, liver functions, complications and outcomes of cirrhosis were recorded. NPAR was calculated through the ratio of neutrophil percentage (%)/serum albumin concentration (g/dL) at admission to the hospital. Cox proportional hazards models were performed to evaluate the prognostic values of NPAR, and subgroup analyses were utilized to ensure stable results. Results A total of 376 patients with decompensated liver cirrhosis at baseline were enrolled. The liver dysfunction, cirrhosisrelated complications and mortality rate increased along with the tertiles of NPAR. In multivariate analysis, higher NPARs were independently associated with increased risk of mortality in patients with liver cirrhosis after adjustments for confounding factors (tertile 3 versus tertile 1: adjusted HR = 1.92; 95% CI, 1.04-3.56; P trend = 0.008) and each unit increase of NPAR implicated a 4% increase risk of mortality. Subgroup analysis demonstrated no significant interactions in most subgroups. Conclusion Increased NPAR was independently correlated with a higher risk of mortality in patients with liver cirrhosis.

Predictive role of neutrophil‐percentage‐to‐albumin, neutrophil‐to‐lymphocyte and eosinophil‐to‐lymphocyte ratios for mortality in patients with COPD: Evidence from NHANES 2011–2018

“…NPAR is a relatively new inflammatory marker, and few studies have explored its prognostic value. 30 However, NPAR has been shown to correlate with prognosis in various other diseases. A previous study noted that higher NPAR was associated with an increased risk of all-cause mortality in critically ill patients with severe sepsis or septic shock.…”

“…In the present study, we confirmed that NPAR and NLR are both predictive of COPD mortality, and the performance of NPAR is slightly better than that of NLR. NPAR is a relatively new inflammatory marker, and few studies have explored its prognostic value 30 . However, NPAR has been shown to correlate with prognosis in various other diseases.…”

The Association of Nonalcoholic Fatty Liver Disease With Neutrophil-to-Lymphocyte Ratio and Neutrophil-Percentage-to-Albumin Ratio

“…In patients with septic shock [ 23 ], acute renal injury [ 24 ], and palliative pancreatic cancer [ 25 ], NPAR, which integrates albumin and NLR, is employed as a systemic inflammation predictor. Additionally, NPAR is linked to mortality among individuals with liver cirrhosis and atrial fibrillation [ 26 , 27 ]. We observed a similar significant association between NPAR and the presence of NAFLD in a recent study by Liu et al They reported a statistically significant correlation (14.3 ± 0.1, p=0.013) between NPAR and NAFLD, and these results are in line with our findings [ 16 ].…”

Circulating neutrophil anti-pathogen dysfunction in cirrhosis

“… 101 Interestingly, neutrophil to albumin ratio is linked to mortality in patients with decompensated cirrhosis. 102 , 103 Given the ability of albumin to bind bacterial products, ROS, and nitric oxide, 104 the changes in its abundance and structure might contribute to neutrophil dysfunction. The addition of albumin to incubation media has been shown to decrease the number of neutrophils with high basal ROS production and reverse phagocytic capacity defects caused by plasma from patients with cirrhosis.…”