Association between neutrophil percentage-to-albumin ratio (NPAR) and long-term mortality in community-dwelling adults with chest pain: Evidence from US NHANES 2001–2018

Abstract

Objective

The neutrophil percentage-to-albumin ratio (NPAR) is a readily available biomarker with prognostic significance across various disease conditions. However, its role in predicting mortality among community patients with chest pain remains underexplored. This study examined NPAR's association with long-term mortality in adults with chest pain using NHANES 2001–2018 data.

Methods

We analyzed data from 6846 community-dwelling adults reporting chest pain. Cox proportional hazards regression models, restricted cubic spline (RCS) analysis, and Kaplan–Meier survival curves were employed to evaluate the relationship between NPAR and the risk of all-cause and cardiovascular mortality. Models were adjusted for demographic, clinical, and laboratory covariates.

Results

Participants were categorized into tertiles based on NPAR values: T1 (<13.0), T2 (13.0–15.0), and T3 (>15.0). Multivariable analysis revealed that the T3 cohort demonstrated significantly increased risks of all-cause mortality (HR 1.56, 95% CI 1.32–1.84, P < 0.001) and cardiovascular mortality (HR 1.86, 95% CI 1.37–2.51, P < 0.001) relative to T1. RCS analysis identified a J-shaped relationship between NPAR and mortality risk, with a significant inflection point at NPAR >13.5 (P for non-linearity <0.001). Incremental analysis showed that each unit increase in NPAR was associated with an 11% higher risk of all-cause mortality (HR 1.11, 95% CI 1.07–1.14, P < 0.001) and a 14% increased risk of cardiovascular mortality (HR 1.14, 95% CI 1.08–1.20, P < 0.001).

Conclusions

Elevated NPAR levels are independently associated with increased long-term mortality in adults with chest pain. These findings position NPAR as a promising prognostic biomarker in this patient population.

Resumen

Objetivo

La relación entre el porcentaje de neutrófilos y la albúmina (NPAR) es un biomarcador pronóstico en diversas enfermedades, pero su papel en la mortalidad de pacientes comunitarios con dolor torácico permanece poco explorado.

Métodos

Se analizaron datos de 6.846 adultos con dolor torácico. Se usaron modelos de regresión de Cox, análisis de splines cúbicos restringidos (RCS) y curvas de Kaplan-Meier para evaluar la relación entre el NPAR y el riesgo de mortalidad.

Resultados

Los participantes se dividieron en terciles de NPAR: T1 (< 13,0), T2 (13,0-15,0) y T3 (> 15,0). El análisis multivariable mostró que el tercil T3 tenía un mayor riesgo de mortalidad por cualquier causa (HR: 1,56; IC 95%: 1,32-1,84; p < 0,001) y mortalidad cardiovascular (HR: 1,86; IC 95%: 1,37-2,51; p < 0,001). El análisis RCS reveló una relación en forma de J con un punto de inflexión en NPAR > 13,5 (p para no linealidad < 0,001). Cada unidad de aumento en NPAR se asoció con un 11% mayor riesgo de mortalidad por cualquier causa y un 14% mayor riesgo de mortalidad cardiovascular.

Conclusión

Niveles elevados de NPAR se asocian de manera independiente con mayor mortalidad a largo plazo en los adultos con dolor torácico, posicionándolo como biomarcador prometedor.