Association of neutrophil-percentage-to-albumin ratio with mortality in cardiovascular disease patients complicating abnormal glucose metabolism

Abstract Background Cardiovascular disease (CVD) patients complicated with abnormal glucose metabolism are at especially higher risk of cardiovascular mortality. Therefore, it is critical to identify and manage CVD patients complicated with abnormal glucose metabolism at higher risk of mortality to improve the overall prognosis of such population. Evidence regarding neutrophil-percentage-to-albumin ratio (NPAR) and survival outcomes in CVD patients complicated with abnormal glucose metabolism remains scarce. Purpose To prospectively evaluate the association of NPAR with cardiovascular and all-cause mortality in CVD patients complicating abnormal glucose metabolism. Methods This study included 3,897 CVD patients with diabetes or pre-diabetes from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Mortality status was determined by access to NHANES public-use linked mortality files. Multivariate Cox proportional hazards regression analysis, threshold effect analysis, and stratified analysis were performed to examine the association of NPAR with cardiovascular and all-cause mortality. The prognostic value of NPAR was further assessed by time-dependent receiver operating characteristic (ROC) curve analysis. Results During a median follow-up period of 76 months, there were 703 cardiovascular deaths and 1,727 all-cause deaths. After adjusting for confounders, NPAR was positively nonlinear associated with cardiovascular and all-cause mortality. Furthermore, the thresholds of NPAR were identified for cardiovascular and all-cause mortality as 14.10 and 14.49, respectively. When the NPAR exceeded the thresholds, a 1-unit increase of NPAR was associated with a 16% and 18% greater hazard ratio (HR) for cardiovascular (HR = 1.16, 95% confidence interval (CI) = 1.08–1.23, P < 0.001) and all-cause mortality (HR = 1.18, 95% CI = 1.13–1.22, P < 0.001), respectively. The time-dependent ROC curve analysis showed that the NPAR had moderate prognostic value and outperformed the neutrophil-to-lymphocyte ratio for predicting short-term survival outcomes. Conclusions The NPAR is a superior predictor of survival outcomes in CVD patients complicated with abnormal glucose metabolism. The thresholds of 14.10 and 14.49 for cardiovascular and all-cause mortality, respectively.