Huang Jie, Zhang Xiaowei, Ding Luyao, Yu Jiaxiang, Lin Mingshen
Department of Cardiology, Lishui Municipal Central Hospital, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
Department of Clinical Laboratory, Lishui Municipal Central Hospital, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
Front Aging Neurosci. 2025 May 30;17:1611289. doi: 10.3389/fnagi.2025.1611289. eCollection 2025.
The neutrophil-percentage-to-albumin ratio (NPAR) functions as an integrative marker representing inflammatory response and nutritional health. However, its association with mortality in elderly stroke survivors has not been explored.
This cohort study analyzed data from 1,026 elderly stroke survivors in the National Health and Nutrition Examination Survey (NHANES, 1999-2018). The association of NPAR with mortality was analyzed using Cox proportional hazards regression, restricted cubic splines (RCS), Kaplan-Meier survival analysis, and time-dependent receiver operating characteristic (ROC) curves. Subgroup analyses and interaction tests were also performed.
During the 6.65-year median follow-up, elevated NPAR showed independent associations with increased all-cause and cardiovascular mortality. Quartile-based analysis revealed 69 and 87% greater mortality hazards for the highest versus lowest NPAR groups, respectively. RCS analysis revealed a non-linear threshold effect at NPAR = 14.5, beyond which the risk of all-cause mortality increased sharply. NPAR demonstrated stable predictive accuracy, with time-dependent AUC ranging from 0.664 to 0.607 for all-cause mortality and 0.652-0.609 for cardiovascular mortality over 3-10 years. Subgroup analyses confirmed consistency across different sex, BMI, lifestyle habits, and comorbidity categories.
This study underscores a strong positive correlation between NPAR and prognosis in older adult stroke survivors in the United States, indicating its potential as a novel biomarker for prognostic assessment.
中性粒细胞百分比与白蛋白比值（NPAR）作为一种综合标志物，代表炎症反应和营养健康状况。然而，其与老年卒中幸存者死亡率的关联尚未得到探究。
这项队列研究分析了美国国家健康与营养检查调查（NHANES，1999 - 2018年）中1026名老年卒中幸存者的数据。使用Cox比例风险回归、受限立方样条（RCS）、Kaplan - Meier生存分析和时间依赖性受试者工作特征（ROC）曲线分析NPAR与死亡率的关联。还进行了亚组分析和交互作用检验。
在6.65年的中位随访期内，NPAR升高与全因死亡率和心血管死亡率增加独立相关。基于四分位数的分析显示，NPAR最高组与最低组的死亡风险分别高出69%和87%。RCS分析显示，NPAR = 14.5时存在非线性阈值效应，超过该值后全因死亡率风险急剧增加。NPAR显示出稳定的预测准确性，在3至10年期间，全因死亡率的时间依赖性AUC范围为0.664至0.607，心血管死亡率的时间依赖性AUC范围为0.652至0.609。亚组分析证实了在不同性别、体重指数、生活方式习惯和合并症类别中的一致性。
本研究强调了美国老年卒中幸存者中NPAR与预后之间存在强正相关，表明其作为预后评估新生物标志物的潜力。
