中性粒细胞与白蛋白比值及全因死亡和心血管死亡风险：对36428名美国成年人的20年随访队列研究

Neutrophil percentage-to-albumin ratio and the risk of all-cause and cardiovascular mortality: a 20-year follow-up cohort study of 36,428 US adults.

作者信息

Han Dunzheng, Wu Lanlan, Zhou Haobin, Li Peixin, Liu Shenrong, Xue Yuting, He Shangfei, Ma Zhuang, Su Shuwen, Huang Zheng

机构信息

Department of Cardiology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510120, China.

出版信息

BMC Public Health. 2025 Apr 22;25(1):1483. doi: 10.1186/s12889-025-22764-7.

DOI:10.1186/s12889-025-22764-7

PMID:40264041

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12013024/

Abstract

BACKGROUND

The neutrophil percentage-to-albumin ratio (NPAR) has been identified as a prognostic indicator of mortality in various diseases; however, its association with all-cause and cardiovascular mortality in the general population remains insufficiently studied.

METHODS

This retrospective cohort study analyzed data from 36,428 individuals who participated in the National Health and Nutrition Examination Survey between 1999 and 2018. Participants were divided into tertiles based on NPAR levels, with follow-up data collected through December 31, 2019. Weighted multivariable Cox regression models were employed to assess the associations between NPAR and both all-cause and cardiovascular mortality. Kaplan-Meier survival analyses were used to compare survival rates across NPAR tertiles. Additionally, restricted cubic spline analyses and subgroup and sensitivity analyses were conducted to further investigate these associations.

RESULTS

During the follow-up period of up to 20 years, 4,716 deaths occurred among the 36,428 participants, including 1,260 deaths attributed to cardiovascular disease. At baseline, the mean NPAR was 13.66 (SD 2.42), the average age was 45.75 years (SD 16.20), and 50.33% of participants were female. Multivariable analyses showed that individuals in the highest NPAR tertile had a significantly increased risk of both all-cause mortality (HR, 95% CI: 1.45, 1.33-1.57) and cardiovascular mortality (HR, 95% CI: 1.69, 1.39-2.06). Kaplan-Meier survival curves demonstrated significant differences in both all-cause and cardiovascular mortality across NPAR groups. A nonlinear association was observed between NPAR and the risk of both all-cause and cardiovascular mortality. Sensitivity analyses confirmed the robustness of these associations. Additionally, a significant interaction between NPAR and hypertension was identified in relation to all-cause mortality (relative excess risk due to interaction, 95% CI: 0.20, 0.07-0.34; multiplicative interaction, P = 0.04).

CONCLUSIONS

An elevated baseline NPAR is independently associated with an increased risk of all-cause and cardiovascular mortality.

摘要

背景

中性粒细胞百分比与白蛋白比值（NPAR）已被确定为多种疾病死亡率的预后指标；然而，其与普通人群全因死亡率和心血管死亡率的关联仍未得到充分研究。

方法

这项回顾性队列研究分析了1999年至2018年间参加美国国家健康和营养检查调查的36428人的数据。参与者根据NPAR水平分为三分位数，并收集截至2019年12月31日的随访数据。采用加权多变量Cox回归模型评估NPAR与全因死亡率和心血管死亡率之间的关联。Kaplan-Meier生存分析用于比较各NPAR三分位数的生存率。此外，进行了限制性立方样条分析以及亚组和敏感性分析，以进一步研究这些关联。

结果

在长达20年的随访期内，36428名参与者中有4716人死亡，其中1260人死于心血管疾病。基线时，平均NPAR为13.66（标准差2.42），平均年龄为45.75岁（标准差16.20），50.33%的参与者为女性。多变量分析显示，NPAR最高三分位数的个体全因死亡率（HR，95%CI：1.45，1.33 - 1.57）和心血管死亡率（HR，95%CI：1.69，1.39 - 2.06）的风险显著增加。Kaplan-Meier生存曲线显示各NPAR组在全因死亡率和心血管死亡率方面存在显著差异。观察到NPAR与全因死亡率和心血管死亡率风险之间存在非线性关联。敏感性分析证实了这些关联的稳健性。此外，在全因死亡率方面，发现NPAR与高血压之间存在显著交互作用（交互作用导致的相对超额风险，95%CI：0.20，0.07 - 0.34；相乘交互作用，P = 0.04）。