The Neutrophil-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Heart Failure

Hu, Zesong; Wang, Jie; Xue, Yan; Zhang, Qianqian; Xu, Qing; Ji, Kangting; Yin, Rong‐Hua

doi:10.2147/jir.s349996

Cited by 22 publications

(16 citation statements)

References 38 publications

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“…The authors evaluated 30-day, inhospital, 90-day, and 365-day mortality in patients with HF admitted to the intensive care units (ICUs). The HR (95% CI) of the upper tertile (> 27.64) was associated with 2.29-fold 30-day mortality compared with the reference value (< 22.56), and an NPAR > 27.64 was also independently associated with 90-day and 365-day all-cause mortality risk [15], which is in line with our findings.…”

Section: Discussionsupporting

confidence: 91%

“…In contrast, they reported AUCs for combing the Simplified Acute Physiology Score II (SAPS II) and NPAR Abbreviations: HR, hazard ratio; AUC, the area under the ROC curve; CI, confidence interval; NPAR, neutrophil percentage-to-albumin ratio; PLR, platelet-tolymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; BMI, body mass index; DM, diabetes mellitus (AUC = 0.731). They concluded that incorporating NPAR can improve the predictive ability of SAPS II ICU scores [15]. Our results reveal that a single test of NPAR alone may not be sufficient to predict long-term mortality in HF patients.…”

Section: Discussionmentioning

confidence: 70%

“…Recently, another blood marker derived from the routine blood sample, the neutrophil percentage-to-albumin ratio (NPAR), combines blood neutrophils and albumin and has been demonstrated to be a potentially useful prognostic indicator for mortality in patients with acute myocardial infarction (AMI) [12], cardiogenic shock [13], coronary artery disease [14], as well as HF in the intensive care unit [15].…”

Section: Introductionmentioning

confidence: 99%

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Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005–2016

Lee

et al. 2023

BMC Cardiovasc Disord

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Background Heart failure (HF) continues to be the major cause of hospitalizations. Despite numerous significant therapeutic progress, the mortality rate of HF is still high. This longitudianl cohort study aimed to investigate the associations between hematologic inflammatory indices neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and all-cause mortality in community-dwelling adults with HF. Methods Adults aged 20 and older with HF in the US National Health and Nutrition Examination Survey (NHANES) database 2005–2016 were included and were followed through the end of 2019. Univariate and multivariable Cox regression analyses were performed to determine the associations between the three biomarkers and all-cause mortality. The receiver operating characteristics (ROC) curve analysis was conducted to evaluate their predictive performance on mortality. Results A total of 1,207 subjects with HF were included, representing a population of 4,606,246 adults in the US. The median follow-up duration was 66.0 months. After adjustment, the highest quartile of NPAR (aHR = 1.81, 95%CI: 1.35, 2.43) and NLR (aHR = 1.59, 95%CI: 1.18, 2.15) were significantly associated with increased mortality risk compared to the lowest quartile during a median follow-up duration of 66.0 months. Elevated PLR was not associated with mortality risk. The area under the ROC curve (AUC) of NPAR, NLR, and PLR in predicting deaths were 0.61 (95%CI: 0.58, 0.65), 0.64 (95%CI: 0.6, 0.67), and 0.58 (95%CI:0.55, 0.61), respectively. Conclusions In conclusion, elevated NPAR and NLR but not PLR are independently associated with increased all-cause mortality among community-dwelling individuals with HF. However, the predictive performance of NPAR and NLR alone on mortality was low.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

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Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005–2016

Lee

et al. 2023

BMC Cardiovasc Disord

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“…concluded that the hospital admission NPAR value was related to the risk of death or hospitalization in an analyzed group of patients [32]. The advantage of NPAR is its simplicity, low cost and availability, because it can be easily and quickly calculated from routine laboratory results in each HF patient on admission.…”

Section: Discussionmentioning

confidence: 99%

Markers of malnutrition, inflammation and tissue remodeling are associated with one-year outcomes in patients with advanced heart failure

Kurkiewicz¹,

Gąsior²,

Szyguła-Jurkiewicz³

2023

Polish Archives of Internal Medicine

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In this single-center study we found that fetal tenascin-C is associated with one-year mortality in patients with advanced heart failure. This extracellular matrix glycoprotein could reflect the extent of myocardial remodeling -upregulates the activity of matrix metalloproteinases and their tissue inhibitors, is involved in degradation of connective tissue, stimulates the inflammatory response and influences the myocardial fibrosis. Furthermore our analysis demonstrated that advanced lung cancer inflammation index and neutrophil percentage-toalbumin ratio which reflect inflammation and malnutrition allow for risk stratification in analyzed group of patients.

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“…Recently, many new indices derived from the leukocyte count or percentages and albumin, such as NLAR, LAR, and NPAR, have been proposed as prognostic markers, and those indices have proven to be more sensitive than conventional systemic inflammation markers for predicting mortality or other poor outcomes of coronavirus pneumonia, heart failure, hepatitis, cirrhosis, STEMI, and cardiogenic shock. For instance, the neutrophil percentage-to-albumin ratio (NPAR) has been shown to be a reliable systemic inflammation-based predictor of mortality in a variety of diseases [ 5 , 6 ]. Thus far, most of the studies that previously assessed the association between atrial fibrillation and systemic or severe inflammation did not include the leukocyte count and albumin-derived ratios.…”

Section: Introductionmentioning

confidence: 99%

The relationship between leukocyte to albumin ratio and atrial fibrillation severity

Lessomo

Fan

Wang

et al. 2023

BMC Cardiovasc Disord

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Background An increased leukocyte count is a sign of inflammation and has been demonstrated to be a predisposing factor and complication of atrial fibrillation. Similarly, albumin, the major protein in the serum, is also considered an acute phase reactant protein that has osmotic and anti-inflammatory properties, and a low albumin level is a known factor associated with severity in many pathologies, including atrial fibrillation. The neutrophil percentage-to-albumin ratio (NPAR) and other emerging leukocyte counts/albumin ratios have been reliable systemic inflammation-based predictors of mortality and complications in various diseases, but they have not yet been used with atrial fibrillation. This study’s aim was to explore whether the leukocyte to albumin ratio could also serve as a useful index in estimating atrial fibrillation severity, including the severity of atrial fibrillation secondary to stroke, to provide a new and more objective tool than the conventional and medical history-based CHA2DS2–VASc score. Materials and methods Data were retrospectively collected from the Wuhan University Zhongnan Hospital database from January 1st to December 31st, 2021. The patients were classified into 2 groups: Group 1-low severity and Group 2- moderate to high severity, and diverse statistical analyses were conducted to evaluate the relationship between the leukocyte-to-albumin ratio and AF severity. Results Only 2329 test subjects met the inclusion criteria. We had 727 test subjects (381 males and 346 females) categorized into the low severity cohort and 1601 test subjects (932 males and 670 females) in the moderate to high severity group. The difference in mean age between the two groups was significant (95% CI [−2.682 to −0.154] p = 0.028), and the difference in the LAR mean rank between the two groups was significant (p = 0.00). The Chi-square test of association yielded the following results: the relationship between the LAR level and category of severity was statistically significant (p = 0.00), and the Mantel‒Haenszel statistic association odds ratio was OR = 0.657. 95% CI OR [0.549–0.787] p = 0.000. The association between sex and atrial fibrillation severity also reached statistical significance. However, sex and LAR were found to be independent factors in atrial fibrillation (Chi-square p value = 0.564). Conclusion It has been demonstrated throughout this investigation that the leukocyte to albumin ratio could provide key clues in clinical practice and contribute to thromboembolism risk assessment in the setting of atrial fibrillation.

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The Neutrophil-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Heart Failure

Cited by 22 publications

References 38 publications

Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005–2016

Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005–2016

Markers of malnutrition, inflammation and tissue remodeling are associated with one-year outcomes in patients with advanced heart failure

The relationship between leukocyte to albumin ratio and atrial fibrillation severity

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