The combined association of the neutrophil percentage-to-albumin ratio (NPAR) and the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) with adverse cardiac events in patients with chronic heart failure: a retrospective cohort study

The neutrophil percentage to albumin ratio (NPAR) and uric acid to high-density lipoprotein cholesterol ratio (UHR) are associated with adverse cardiovascular (CV) outcomes. However, their combined prognostic value in chronic heart failure (CHF) patients remains unexplored. This retrospective cohort study aimed to investigate their combined prognostic value in CHF patients. This study included 1,331 patients diagnosed with CHF at Nanjing Drum Tower Hospital from 2019 to 2023. The primary outcomes encompassed CV death and major adverse cardiac and cerebral events (MACCEs). Kaplan-Meier analysis and Cox proportional hazard model were performed to explore the association between these indices and clinical outcomes. The discriminatory performance of the models was evaluated using time-dependent receiver operating characteristic (ROC) analysis at 1-, 2-, and 3-year follow-up intervals. Over a median follow-up of 1.9 years in 1,331 patients, 357 MACCEs (26.8%) and 148 CV deaths (11.1%) were recorded. After multivariable adjustment (Model 3), the group with high UHR and high NPAR exhibited a significantly higher risk of CV death (hazard ratio [HR] = 3.53, 95% CI: 2.09–5.97; $$P < 0.001$$) and MACCEs (HR = 1.46, 95% CI: 1.03–2.06; $$P = 0.031$$), compared to the group with low UHR and low NPAR. ROC analysis demonstrated superior discriminatory ability of the UHR–NPAR combined model for 1-year CV events (AUC = 0.787) and 2-year MACCEs (AUC = 0.609), significantly outperforming UHR alone. The model showed variable performance across time points, with NPAR alone demonstrating better discrimination for 3-year outcomes in both CV events (AUC = 0.676) and MACCEs (AUC = 0.597). The UHR and NPAR were independently and jointly associated with the risk of CV death and MACCEs in patients with CHF. By integrating these complementary biomarkers, our composite approach represents a potential novel tool for enhancing risk stratification and could inform patient management.