Neutrophil Percentage-to-Albumin Ratio and Heart Failure Mortality: A Systematic Review

Inflammation and malnutrition are important contributors to adverse outcomes in heart failure (HF). The neutrophil percentage-to-albumin ratio (NPAR), derived from routinely available laboratory parameters, integrates inflammatory burden and nutritional status and may provide prognostic value. We conducted a systematic review in accordance with the PRISMA 2020 guidelines to evaluate the association between baseline or admission NPAR and all-cause mortality in adults with HF. Two independent reviewers performed study selection and data extraction, and methodological quality was assessed using the Newcastle–Ottawa Scale. Because of heterogeneity in study populations, NPAR cutoff values, and outcome definitions, meta-analysis was not performed and findings were synthesized narratively. Five observational cohort studies comprising more than 4900 patients were included. Across all studies, elevated NPAR was consistently associated with increased short-term (30–90 days) and long-term (1–5 years) all-cause mortality in diverse HF populations, with reported hazard ratios ranging from 1.52 to 2.18. Several studies also demonstrated superior prognostic performance of NPAR compared with neutrophil percentage or serum albumin alone. However, reported NPAR cutoff values varied and remain unstandardized. Elevated NPAR is consistently associated with increased all-cause mortality in patients with HF and may serve as a simple, cost-effective tool for clinical risk stratification. Prospective studies are needed to establish standardized thresholds and validate its prognostic utility across HF phenotypes and clinical settings.