Association between NPS and all-cause and cardiovascular mortality in US adults with diabetes mellitus

Objective: this study aimed to assess the association between the Naples Prognostic Score (NPS) and all-cause as well as cardiovascular mortality in US adults with type 2 diabetes mellitus (T2DM). Methods: data were obtained from the National Health and Nutrition Examination Survey (NHANES) spanning 2001-2018. Multivariable-adjusted Cox proportional hazards models, Kaplan-Meier survival analysis, and restricted cubic spline (RCS) analyses were used to evaluate the relationship between NPS and mortality outcomes. Subgroup analyses were conducted based on age, sex, education, body mass index (BMI), smoking status, alcohol consumption, and histories of hypertension and hyperlipidemia. Results: a total of 3,663 adults with T2DM were included. Higher NPS was significantly associated with increased all-cause and cardiovascular mortality after adjustment for potential confounders (all p-values < 0.001). Compared to Group 0 (NPS = 0), Group 2 (NPS = 3-4) had a hazard ratio (HR) of 2.22 (95 % CI: 1.46-3.38; p < 0.001) for all-cause mortality and an HR of 2.23 (95 % CI: 1.01-4.93; p = 0.047) for cardiovascular mortality. RCS analysis demonstrated a J-shaped non-linear association between NPS and all-cause and cardiovascular mortality (p for nonlinearity < 0.0001 and 0.0192, respectively). Conclusion: the results of this study suggest that NPS is independently associated with increased risks of all-cause and cardiovascular mortality in US adults with T2DM. These findings indicate that NPS may be a useful prognostic marker in this population and help inform clinical management strategies.