Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005-2016

• Published in: BMC cardiovascular disorders Vol. 23; no. 1; p. 312
• Main Authors: Wu, Chia-Chen, Wu, Chia-Hui, Lee, Chien-Ho, Cheng, Cheng-I
• Format: Journal Article
• Language: English
• Published: England BioMed Central 21.06.2023; BMC
• Subjects: Adult; Albumin; Albumins; Biomarkers; Blood Platelets; Blood pressure; Cardiovascular disease; Cholesterol; Chronic obstructive pulmonary disease; Cohort Studies; Congestive heart failure; Creatinine; Diabetes; Disease control; Glucose; Heart failure; Heart failure (HF); Heart Failure - diagnosis; Heart Failure - therapy; Hospitals; Humans; Hypertension; Independent Living; Inflammation; Interviews; Leukocytes (neutrophilic); Lymphocytes; Medical laboratories; Mortality; National Health and Nutrition Examination Survey (NHANES); Neutrophil percentage-to-albumin ratio (NPAR); Neutrophil-to-lymphocyte ratio (NLR); Neutrophils; Nutrition Surveys; Platelet Count; Platelet-to-lymphocyte (PLR); Platelets; Prognosis; Questionnaires; Research ethics; Retrospective Studies; Review boards; Smoking; Variables; United States > US; National Health and Nutrition Examination Survey (NHANES); Neutrophil-to-lymphocyte ratio (NLR); Neutrophil percentage-to-albumin ratio (NPAR); Platelet-to-lymphocyte (PLR); Mortality; Heart failure (HF)
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-023-03316-6

Heart failure (HF) continues to be the major cause of hospitalizations. Despite numerous significant therapeutic progress, the mortality rate of HF is still high. This longitudianl cohort study aimed to investigate the associations between hematologic inflammatory indices neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and all-cause mortality in community-dwelling adults with HF. Adults aged 20 and older with HF in the US National Health and Nutrition Examination Survey (NHANES) database 2005-2016 were included and were followed through the end of 2019. Univariate and multivariable Cox regression analyses were performed to determine the associations between the three biomarkers and all-cause mortality. The receiver operating characteristics (ROC) curve analysis was conducted to evaluate their predictive performance on mortality. A total of 1,207 subjects with HF were included, representing a population of 4,606,246 adults in the US. The median follow-up duration was 66.0 months. After adjustment, the highest quartile of NPAR (aHR = 1.81, 95%CI: 1.35, 2.43) and NLR (aHR = 1.59, 95%CI: 1.18, 2.15) were significantly associated with increased mortality risk compared to the lowest quartile during a median follow-up duration of 66.0 months. Elevated PLR was not associated with mortality risk. The area under the ROC curve (AUC) of NPAR, NLR, and PLR in predicting deaths were 0.61 (95%CI: 0.58, 0.65), 0.64 (95%CI: 0.6, 0.67), and 0.58 (95%CI:0.55, 0.61), respectively. In conclusion, elevated NPAR and NLR but not PLR are independently associated with increased all-cause mortality among community-dwelling individuals with HF. However, the predictive performance of NPAR and NLR alone on mortality was low.