Neutrophil percentage to albumin ratio predicts all-cause and cardiovascular mortality in patients with diabetes or prediabetes from NHANES 1999–2018
Abstract This cohort study investigated the association between neutrophil percentage-to-albumin ratio (NPAR) and mortality risks in U.S. adults with diabetes or prediabetes using National Health and Nutrition Examination Survey (NHANES) data (1999–2018). Among 101,316 screened participants, 47,477...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-07-01
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| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-06313-1 |
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| Summary: | Abstract This cohort study investigated the association between neutrophil percentage-to-albumin ratio (NPAR) and mortality risks in U.S. adults with diabetes or prediabetes using National Health and Nutrition Examination Survey (NHANES) data (1999–2018). Among 101,316 screened participants, 47,477 eligible individuals (7,171 diabetes; 15,175 prediabetes) were analyzed after exclusions for age < 20 years, pregnancy, and missing data. NPAR was calculated as neutrophil percentage divided by albumin (g/dL). Mortality outcomes were ascertained via linkage to the National Death Index through 2019. Weighted multivariable Cox models adjusted for sociodemographic, metabolic, and clinical covariates revealed a J-shaped relationship between NPAR and mortality. Over a median follow-up of 99.5 months (IQR: 58–142), the highest NPAR quartile (Q4) demonstrated significantly elevated all-cause mortality (HR 1.585, 95% CI 1.434–1.753) and cardiovascular mortality (HR 1.642, 95% CI 1.370–1.969) compared to Q1. Restricted cubic spline analysis identified an inflection point at NPAR = 1.399. Below this threshold, NPAR associated only with cardiovascular mortality (HR 1.871, 95% CI 1.249–2.804), while values above 1.399 markedly increased risks for both all-cause (HR 3.241, 95% CI 2.343–4.483) and cardiovascular mortality (HR 2.062, 95% CI 1.213–3.503). Subgroup analyses confirmed consistency across age, gender, BMI, and comorbidity strata. These findings position NPAR as a novel integrative biomarker reflecting inflammatory-nutritional interplay, with critical prognostic value for mortality risk stratification in dysglycemic populations. |
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| ISSN: | 2045-2322 |