Abstract Background Acute heart failure carries substantial risks of complications and mortality with generally poor prognosis, rendering the identification of sensitive prognostic biomarkers crucial for early risk stratification. The neutrophil percentage-to-albumin ratio (NPAR), a new inflammation-integrated biomarker, demonstrated superior predictive capability in reflecting systemic inflammatory burden. Previous studies have confirmed that the NPAR serves as a reliable prognostic predictor for various diseases, including coronary heart disease, atrial fibrillation, and septic shock. However, the association between NPAR and mortality in patients with acute heart failure (AHF) remains unclear. Purpose The study aimed to evaluate the relationship between NPAR and mortality in patients with AHF. Methods We analyzed the data from China Patient- centred Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p-HF Study), in which patients hospitalized for AHF from 52 Chinese hospitals were recruited from 2016 to 2018. Primary outcomes were all-cause and cardiovascular mortality. Multivariable Cox proportional hazards regression model was used to confirm the association between NPAR and mortality. Restricted cubic spline analysis was employed to examine the dose-effect relationship between NPAR and mortality risk. Receiver operating characteristic (ROC) curves and Harrell's concordance index (C-index) were used to compare the ability of different inflammatory biomarkers to predict mortality. Subgroup analysis was introduced to evaluate the heterogeneity between NPAR and mortality under different heart failure subtypes or serum N-terminal pro-B type natriuretic peptide (NT-proBNP) levels. Results A total of 4622 patients with AHF were included. During a median follow-up of 4.6 years, 2156 (46.7%) all-cause deaths and 1499 (32.4%) cardiovascular deaths were documented. Patients in the highest NPAR quartile had a significantly increased risk of all-cause mortality (HR: 1.71, 95% CI: 1.49-1.96) and cardiovascular mortality (HR:1.72, 95% CI: 1.45–2.03) compared to those in the lowest quartile in the fully adjusted model. NPAR levels exhibited significant nonlinear relationships with both all-cause mortality (P for non-linearity = 0.017) and cardiovascular mortality (P for non-linearity = 0.015). The predictive performances of NPAR for all-cause and cardiovascular mortality were better than that of high-sensitivity C-reactive protein (C-index 0.72 vs. 0.70, P 0.001, both). Subgroup analysis revealed the relationship between NPAR and mortality was stable, irrespective of heart failure subtypes and serum NT-proBNP levels. Conclusions Elevated NPAR levels increased the risk of long-term mortality in patients with AHF. The findings demonstrate that NPAR, as a novel inflammatory biomarker with high clinical accessibility, may refine risk stratification frameworks and optimize therapeutic decision-making in AHF management.Associations between NPAR and motality Dose-response curves
Chen et al. (2025) studied this question.
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