Elevated neutrophil percentage-to-albumin ratio predicts increased all-cause and cardiovascular mortality among individuals with diabetes

Evidence regarding the neutrophil percentage-to-albumin ratio (NPAR) and mortality risk in diabetes patients is scarce. This study aimed at investigating the prognostic value of NPAR for mortality in patients with diabetes. This retrospective analysis was conducted on 6,962 diabetic patients from the NHANES database. Restricted cubic spline (RCS) was used to visualize the association of the NPAR with mortality risk. Weighted multivariable Cox regression models and subgroup analyses were adopted to assess the association of the NPAR with all-cause and cardiovascular mortality. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to evaluate the accuracy of the NPAR in predicting survival outcomes. Mediation analysis explored the indirect impact of NPAR on mortality mediated through eGFR. During a median follow-up of 6.7 years, there were 1,804 deaths were recorded, including 602 cardiovascular deaths. The RCS regression showed that NPAR has a J-shaped association with all-cause mortality, and a positive linear association with CVD mortality. Each one-unit increase in NPAR was linked with a 14% and 12% increased risk of all-cause and cardiovascular mortality, respectively. The association was consistent in subgroup analyses based on age, sex, race, BMI, hypertension, CKD, and history of CVD. The time-dependent ROC curve showed the area under the curve of were 0.809 for all-cause mortality, and 0.780 for CVD mortality. In mediation analyses, eGFR partially mediated these relationships. An elevated NPAR is independently associated with increased all-cause and cardiovascular mortality in diabetes patients.