Liu Yuting, Qiu Zifeng, Shen Geng, Sun YangYang, Mei Jiarong, Liu Zhihao, Wang Leyi, Li Jianping
Department of Cardiology, Peking University First Hospital, Beijing, China.
Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China.
Front Cardiovasc Med. 2024 Sep 25;11:1393513. doi: 10.3389/fcvm.2024.1393513. eCollection 2024.
Chronic inflammation is a recognized independent risk factor for cardiovascular disease (CVD), highlighting the need for reliable inflammatory indicator to predict CVDs. As an inflammatory indicator which has been proved to have predictive value for prognosis of CVDs, neutrophil percentage-to-albumin ratio (NPAR) has obtained increasing attention, but further research is needed to confirm the relationship with mortality in the general population.
This prospective cohort study included 21,317 individuals who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010, where baseline characteristics and NPAR level were extracted. Data for CVD and all-cause mortality were acquired by linking the cohort database with the National Death Index through December 31, 2019. We employed restricted cubic spline analyses to examine the nonlinear association. Weighted Kaplan-Meier curves with log-rank tests were conducted to access cumulative survival differences across different NPAR results. Multivariable Cox proportional hazards regression models were used to compute hazard ratios and 95% CIs. Receiver Operating Characteristic (ROC) curves were used to compare predictive value of NPAR with systemic immune inflammation index (SII) and neutrophils percent.
In this cohort study, during 270,014 person-years of follow-up, 4,074 all-cause deaths and 1,116 CVD-cause deaths were documented. NPAR levels exhibited significant nonlinear associations with both CVD-cause ( = 0.018 for nonlinearity) and all-cause mortality ( < 0.001 for nonlinearity). Participants in the highest NPAR tertile had a significantly increased risk of all-cause mortality (HR: 1.46, 95% CI: 1.33-1.61) and CVD-cause mortality (HR: 1.54, 95% CI: 1.32-1.80) compared to those in the lowest tertile in the fully adjusted model, while no association was detected for individuals in the middle tertile. Further ROC analysis confirmed that NPAR had higher predictive value than neutrophil percent segment and SII.
Elevated NPAR level was significantly associated with an increased risk of all-cause and CVD-cause mortality in general population. The high predictive value of NPAR, combined with the easy-to-calculate property, suggests that its potential as a novel inflammatory indicator is worthy of further investigation.
慢性炎症是公认的心血管疾病（CVD）独立危险因素，这凸显了需要可靠的炎症指标来预测心血管疾病。作为已被证明对心血管疾病预后具有预测价值的炎症指标，中性粒细胞与白蛋白比值（NPAR）已受到越来越多的关注，但仍需进一步研究以证实其与普通人群死亡率的关系。
这项前瞻性队列研究纳入了1999年至2010年参加美国国家健康与营养检查调查（NHANES）的21317名个体，从中提取了基线特征和NPAR水平。通过将队列数据库与截至2019年12月31日的国家死亡指数相链接，获取心血管疾病和全因死亡率的数据。我们采用受限立方样条分析来检验非线性关联。使用加权Kaplan-Meier曲线和对数秩检验来评估不同NPAR结果的累积生存差异。多变量Cox比例风险回归模型用于计算风险比和95%置信区间。采用受试者工作特征（ROC）曲线来比较NPAR与全身免疫炎症指数（SII）及中性粒细胞百分比的预测价值。
在这项队列研究中，在270014人年的随访期间，记录了4074例全因死亡和1116例心血管疾病导致的死亡。NPAR水平与心血管疾病导致的死亡（非线性检验P = 0.018）和全因死亡率（非线性检验P < 0.001）均呈现显著的非线性关联。在完全调整模型中，与处于最低三分位数的参与者相比，处于最高NPAR三分位数的参与者全因死亡风险显著增加（风险比：1.46，95%置信区间：1.33 - 1.61），心血管疾病导致的死亡风险也显著增加（风险比：1.54，95%置信区间：1.32 - 1.80），而处于中间三分位数的个体未检测到关联。进一步的ROC分析证实，NPAR比中性粒细胞百分比和SII具有更高的预测价值。
NPAR水平升高与普通人群全因死亡和心血管疾病导致的死亡风险增加显著相关。NPAR的高预测价值，结合其易于计算的特性，表明其作为一种新型炎症指标的潜力值得进一步研究。
