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. 2025 May 30:17:1611289.
doi: 10.3389/fnagi.2025.1611289. eCollection 2025.

Association of neutrophil-percentage-to-albumin ratio with mortality in older stroke survivors

Jie Huang  1 , Xiaowei Zhang  2 , Luyao Ding  1 , Jiaxiang Yu  3 , Mingshen Lin  2
Affiliations

Association of neutrophil-percentage-to-albumin ratio with mortality in older stroke survivors

Jie Huang et al. Front Aging Neurosci. .

Abstract

Background: The neutrophil-percentage-to-albumin ratio (NPAR) functions as an integrative marker representing inflammatory response and nutritional health. However, its association with mortality in elderly stroke survivors has not been explored.

Methods: This cohort study analyzed data from 1,026 elderly stroke survivors in the National Health and Nutrition Examination Survey (NHANES, 1999-2018). The association of NPAR with mortality was analyzed using Cox proportional hazards regression, restricted cubic splines (RCS), Kaplan-Meier survival analysis, and time-dependent receiver operating characteristic (ROC) curves. Subgroup analyses and interaction tests were also performed.

Results: During the 6.65-year median follow-up, elevated NPAR showed independent associations with increased all-cause and cardiovascular mortality. Quartile-based analysis revealed 69 and 87% greater mortality hazards for the highest versus lowest NPAR groups, respectively. RCS analysis revealed a non-linear threshold effect at NPAR = 14.5, beyond which the risk of all-cause mortality increased sharply. NPAR demonstrated stable predictive accuracy, with time-dependent AUC ranging from 0.664 to 0.607 for all-cause mortality and 0.652-0.609 for cardiovascular mortality over 3-10 years. Subgroup analyses confirmed consistency across different sex, BMI, lifestyle habits, and comorbidity categories.

Conclusion: This study underscores a strong positive correlation between NPAR and prognosis in older adult stroke survivors in the United States, indicating its potential as a novel biomarker for prognostic assessment.

Keywords: NHANES; NPAR; elderly; mortality; stroke survivors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the study.
FIGURE 2
FIGURE 2
RCS fitting for the association between NPAR and all-cause (A) and cardiovascular (B) mortality.
FIGURE 3
FIGURE 3
Kaplan–Meier survival analysis plot for all-cause (A) and cardiovascular (B) mortality with quartile groups of NPAR.
FIGURE 4
FIGURE 4
Time-dependent ROC curves and time-dependent AUC values of NPAR for predicting all-cause (A,B) and cardiovascular (C,D) mortality.
FIGURE 5
FIGURE 5
Subgroup analysis of NPAR with all-cause (A) and cardiovascular (B) mortality.
See this image and copyright information in PMC

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