Lu Yue-Xin, Mao Bao-Jie, Wang Ming, Wan Shu
Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Int J Med Sci. 2025 May 28;22(11):2663-2675. doi: 10.7150/ijms.108493. eCollection 2025.
The neutrophil percentage-to-albumin ratio (NPAR) is an emerging inflammatory biomarker that has demonstrated a significant association with poor outcomes in patients with cardiovascular diseases. However, the existing evidence regarding its prognostic value in ischemic stroke (IS) patients remains limited. Our study aimed to investigate the potential of the NPAR as a prognostic indicator for all-cause mortality in patients with IS. This study screened IS patients from the Medical Information Mart for Intensive Care (MIMIC-IV) database and categorized them into two groups based on NPAR values, employing propensity score matching to mitigate confounding factors. The primary outcome assessed was 90‒day mortality, and the secondary outcomes included in-hospital mortality, ICU mortality, and mortality at 30‒day and 1‒year after admission. Cox proportional hazards regression analysis and restricted cubic splines were used to explore the relationship between the NPAR and all-cause mortality in critically ill IS patients, whereas Kaplan‒Meier analysis was used to estimate survival curves. Subgroup analysis and interaction tests were performed to evaluate the robustness of the results. Receiver operating characteristic curves were computed to assess the diagnostic value of the NPAR in predicting outcomes. A total of 706 patients (53.3% male) were included in the study, with in-hospital and ICU mortality rates of 18.2% and 12.6%, respectively. The mortality rates at 30‒day, 90‒day, and 1‒year were 19.2%, 29.7%, and 37.8%, respectively. Restricted cubic splines indicated a nonlinear increase in all-cause mortality as the NPAR increased. Multivariate Cox regression analysis revealed a significant association between a high NPAR and all-cause mortality at 90‒day (hazard ratio [HR]: 1.99; 95% confidence interval [95% CI]: 1.44-2.76, p < 0.001), 30‒day (HR: 2.09; 95% CI: 1.39-3.13, p < 0.001), and 1‒year (HR: 1.77; 95% CI: 1.32-2.37, p < 0.001). The subgroup analysis indicates that a significant interaction was observed between hypertension and mortality risk in IS patients (p for interaction = 0.012), suggesting that hypertension may be an important predictor of poor prognosis in these patients. Receiver operating characteristic curves demonstrated that the NPAR provides a modestly greater ability to predict the risk of death in patients with IS compared to the individual indices of neutrophil percentage and albumin levels, although the specificity (0.567) and sensitivity (0.684) of NPAR were not outstanding overall. Our study revealed an independent association between a high NPAR and increased all-cause mortality at 30‒day, 90‒day, and 1‒year and during hospitalization in patients with IS, reinforcing its status as an independent determinant of mortality risk.
中性粒细胞百分比与白蛋白比值（NPAR）是一种新兴的炎症生物标志物，已证明与心血管疾病患者的不良预后显著相关。然而，关于其在缺血性中风（IS）患者中的预后价值的现有证据仍然有限。我们的研究旨在探讨NPAR作为IS患者全因死亡率预后指标的潜力。本研究从重症监护医学信息数据库（MIMIC-IV）中筛选IS患者，并根据NPAR值将他们分为两组，采用倾向得分匹配来减轻混杂因素。评估的主要结局是90天死亡率，次要结局包括住院死亡率、ICU死亡率以及入院后30天和1年的死亡率。采用Cox比例风险回归分析和受限立方样条来探讨NPAR与重症IS患者全因死亡率之间的关系，而采用Kaplan-Meier分析来估计生存曲线。进行亚组分析和交互检验以评估结果的稳健性。计算受试者工作特征曲线以评估NPAR在预测结局方面的诊断价值。本研究共纳入706例患者（53.3%为男性），住院死亡率和ICU死亡率分别为18.2%和12.6%。30天、90天和1年的死亡率分别为19.2%、29.7%和37.8%。受限立方样条表明，随着NPAR升高，全因死亡率呈非线性增加。多变量Cox回归分析显示，高NPAR与90天（风险比[HR]：1.99；95%置信区间[95%CI]：1.44 - 2.76，p < 0.001）、30天（HR：2.09；95%CI：1.39 - 3.13，p < 0.001）和1年（HR：1.77；95%CI：1.32 - 2.37，p < 0.001）的全因死亡率显著相关。亚组分析表明，IS患者中高血压与死亡风险之间存在显著交互作用（交互作用p值 = 0.012），表明高血压可能是这些患者预后不良的重要预测因素。受试者工作特征曲线表明，与中性粒细胞百分比和白蛋白水平的个体指标相比，NPAR在预测IS患者死亡风险方面具有略强的能力，尽管NPAR的特异性（0.567）和敏感性（0.684）总体上并不突出。我们的研究揭示了高NPAR与IS患者30天、90天和1年以及住院期间全因死亡率增加之间的独立关联，强化了其作为死亡风险独立决定因素的地位。
