Xu Zhiqiang, Pei Minyue, Yang Xiaoqing, Xu Lixia, Zhang Dongya, Li Xiaochang, He Caihong, Guan Ruilei, Zhang Jijun, Xiao Weizhong, Yang Gaiqing
Department of Neurology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450000, China.
Department of Neurology, Peking University Third Hospital, Beijing, 100089, China.
Sci Rep. 2025 Mar 28;15(1):10718. doi: 10.1038/s41598-025-94975-2.
This study seeks to assess the associations of Naples Prognostic Score with stroke in adults and all cause mortality among stroke patients. We analyzed data from 44,601 participants in the 2005-2018 National Health and Nutrition Examination Survey (NHANES). The Naples Prognostic Score (NPS) was derived from total cholesterol, serum albumin, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Participants were classified into three groups based on their NPS. Stroke incidence was determined through self-reported questionnaires, and mortality data were diligently tracked using the National Death Index. We investigated the relationship between NPS and stroke prevalence using multiple logistic regression analysis. To explore the association between NPS and all cause mortality in stroke survivors, we applied Kaplan-Meier survival analysis and Cox proportional hazards models. Furthermore, we conducted a detailed subgroup analysis to assess interaction effects on all cause mortality risk within this population. The median age of the participants was 50.00 years [interquartile range: 35.00-64.00], with males comprising 49.36% of the study. The overall stroke prevalence was 3.93%. Participants were categorized into three groups based on their NPS: 6,328 (18.1%) in Group 0 (NPS 0), 24,015 (68.8%) in Group 1 (NPS 1 or 2), and 4,580 (13.1%) in Group 2 (NPS 3 or 4). After adjusting for covariates, individuals in Group 2 exhibited a significantly higher stroke prevalence compared to Group 0, with an odds ratio (OR) of 1.82 [95% confidence interval: 1.48-2.23]. Among the 1372 patients with a history of stroke, with a median follow-up duration of 5.94 years, we utilized Cox proportional hazards models to assess the relationship between NPS and all cause mortality risk. The analysis revealed that, after adjusting for covariates, stroke patients in Group 2 faced a significantly elevated risk of all cause mortality (hazard ratio [HR] = 2.21 [95% confidence interval: 1.44-3.11]) compared to those in Group 0. Subsequent subgroup analyses to explore interaction effects on all cause mortality risk among stroke patients shown no significant interactions (p for interaction > 0.05). This study indicate a positive correlation between NPS and the risk of stroke in adults, as well as all cause mortality in stroke patients.
本研究旨在评估那不勒斯预后评分与成人中风以及中风患者全因死亡率之间的关联。我们分析了2005 - 2018年国家健康与营养检查调查（NHANES）中44,601名参与者的数据。那不勒斯预后评分（NPS）由总胆固醇、血清白蛋白、中性粒细胞与淋巴细胞比值（NLR）以及淋巴细胞与单核细胞比值（LMR）得出。参与者根据其NPS被分为三组。中风发病率通过自我报告问卷确定，死亡率数据通过国家死亡指数进行认真追踪。我们使用多元逻辑回归分析研究了NPS与中风患病率之间的关系。为了探究NPS与中风幸存者全因死亡率之间的关联，我们应用了Kaplan - Meier生存分析和Cox比例风险模型。此外，我们进行了详细的亚组分析，以评估该人群中对全因死亡风险的交互作用。参与者的中位年龄为50.00岁[四分位间距：35.00 - 64.00]，男性占研究对象的49.36%。总体中风患病率为3.93%。参与者根据其NPS被分为三组：0组（NPS为0）有6328人（18.1%），1组（NPS为1或2）有24,015人（68.8%），2组（NPS为3或4）有4580人（13.1%）。在调整协变量后，2组个体的中风患病率相较于0组显著更高，优势比（OR）为1.82[95%置信区间：1.48 - 2.23]。在1372名有中风病史的患者中，中位随访时长为5.94年，我们使用Cox比例风险模型评估NPS与全因死亡风险之间的关系。分析显示，在调整协变量后，2组中风患者面临的全因死亡风险相较于0组显著升高（风险比[HR] = 2.21[95%置信区间：1.44 - 3.11]）。随后对中风患者中全因死亡风险的交互作用进行的亚组分析未显示出显著的交互作用（交互作用p值>0.05）。本研究表明NPS与成人中风风险以及中风患者全因死亡率之间存在正相关。
