What question did this study set out to answer?

To evaluate NPAR's effectiveness as a predictor of diuretic resistance and mortality in patients with HFpEF.

February 25, 2026Open Access

Neutrophil Percentage-to-Albumin Ratio as a Novel Predictor of Diuretic Resistance and Mortality in Patients with Heart Failure with Preserved Ejection Fraction

Q: What does this research mean for the field?

The Neutrophil Percentage-to-Albumin Ratio (NPAR) independently predicts diuretic resistance and mortality in patients with Heart Failure with Preserved Ejection Fraction (HFpEF). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Neutrophil Percentage-to-Albumin Ratio independently predicts diuretic resistance and mortality in HFpEF, highlighting its role in risk stratification.

Key Points

To evaluate NPAR's effectiveness as a predictor of diuretic resistance and mortality in patients with HFpEF.
Assessment of NPAR levels in heart failure patients
Analysis of diuretic response and mortality outcomes
Investigation of systemic inflammation's role in HFpEF pathophysiology
NPAR independently predicts diuretic resistance in HFpEF patients
Higher NPAR levels correlate with increased mortality risk
Findings indicate systemic inflammation contributes significantly to HFpEF outcomes

Structured PICO

Does an elevated neutrophil percentage-to-albumin ratio predict diuretic resistance and mortality in patients with HFpEF?

Population

1,487 adult patients hospitalized for worsening heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%), mean age ~62, ~58% female, from a single center in Türkiye. Key exclusions: acute infection or sepsis, pulmonary embolism, severe valve disease, malignancy, coagulation disorder, acute or chronic stroke, acute kidney disease, end-stage renal disease, severe anemia, and recent acute coronary syndrome (first 6 months).

Intervention

Neutrophil percentage-to-albumin ratio (NPAR) assessment as a prognostic biomarker

Outcome

Diuretic resistance (composite of hyponatremia, loop diuretic escalation to >160 mg/day and/or metolazone addition, spot urine sodium <50-70 mmol/L, worsening renal function, or need for IV inotropic therapy during index hospitalization) and all-cause mortality at mean 8.3 months follow-uphard clinical

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

NPAR is a simple and accessible inflammatory biomarker that independently predicts diuretic resistance and mortality in HFpEF. The findings underscore the role of systemic inflammation in HFpEF pathophysiology and highlight NPAR as a potential tool for early risk stratification and therapeutic decision-making.

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