What question did this study set out to answer?

This research aims to determine the prognostic significance of the neutrophil percentage-to-albumin ratio (NPAR) in patients experiencing acute decompensated heart failure.

February 6, 2026

Prognostic value of neutrophil percentage-to-albumin ratio in patients with acute decompensated heart failure

Key Points

This research aims to determine the prognostic significance of the neutrophil percentage-to-albumin ratio (NPAR) in patients experiencing acute decompensated heart failure.
Prospective cohort study involving 569 patients admitted for acute decompensated heart failure.
Laboratory data including neutrophil percentage and serum albumin obtained pre-discharge.
Patients categorized into tertiles based on NPAR values and followed for all-cause death over 6 years.
Utilized multivariable Cox analysis to adjust for various confounders, including age and health history.
Applied Kaplan-Meier analysis to assess survival based on NPAR tertiles.
336 patients experienced all-cause death during the follow-up period.
NPAR was significantly higher in patients who died compared to those who survived (19.0 vs 16.8, p<0.001).
Higher tertiles of NPAR corresponded with increased mortality risk, with the highest tertile showing a 74% death risk (adjusted HR: 1.52).
NPAR outperformed either albumin or neutrophil percentage alone in predicting mortality.

Abstract

Abstract Background Neutrophil percentage-to-albumin ratio (NPAR), which is one of inflammatory and malnutritional biomarkers, has been shown to be associated with poor outcome in various diseases. The aim of this study is to investigate the prognostic value of NPAR in patients with acute decompensated heart failure (ADHF). Methods and Results We prospectively studied 569 patients admitted for ADHF discharged with survival in our prospective cohort study. The laboratory data were obtained just before discharge. NPAR was calculated as neutrophil percentage divided by serum albumin. According to the tertiles of NPAR, they were divided into three groups (highest tertile: NPAR ≥ 19.4; middle tertile: 15.8≤NPAR19.4; lowest tertile: NPAR 15.8). The endpoint of this study was all-cause death (ACD). During 6.0±3.7 years, 336 patients had ACD. NPAR was significantly higher in patients with than without ACD (19.0±4.7 vs 16.8±4.2, p0.001). At multivariable Cox analysis, NPAR was significantly associated with ACD independently of age, gender, diabetes mellitus, hemoglobin, BUN, log-BNP, and prior heart failure hospitalization after adjustment for major confounders such NYHA class, systolic blood pressure, BMI, LVEF, history of hypertension, dyslipidemia, and serum creatinine, sodium and C-reactive protein levels. Kaplan–Meier analysis revealed that the risk of ACD significantly increased in accordance with NPAR stratum (highest tertile: 74%, adjusted HR: 1.52 1.12-2.06, middle tertile: 59%, adjusted HR: 1.22 0.90-1.64, compared with lowest tertile: 45%, p 0.0001]. Receiver operating characteristics curve analysis revealed that NPAR had a better ability to predict all-cause mortality in patients with ADHF, than either albumin or the neutrophil percentage alone. Conclusion NPAR is associated with the increased all-cause mortality in patients with ADHF, which suggests that NPAR might be useful for the risk stratification in patients admitted for ADHF after the discharge.Kaplan-Meier curve ROC curve

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