Neutrophil-to-albumin ratio predicts 30-day mortality in acute aortic dissection: a retrospective cohort study

Background: Acute aortic dissection (AAD) carries high early mortality, necessitating reliable prognostic tools. The neutrophil-to-albumin ratio (NPAR) synergistically encapsulates inflammatory activity and nutritional status, yet its prognostic utility in AAD remains underexplored. Methods: We retrospectively enrolled 415 patients with AAD diagnosed at Yuebei People's Hospital between January 2020 and December 2024. NPAR was calculated from admission laboratory values and analyzed as both a continuous and categorical variable (tertiles). Logistic regression models were used to assess the association between NPAR and 30-day mortality. Restricted cubic spline (RCS) analysis examined the dose-response relationship. Receiver operating characteristic analysis compared NPAR with NLR, SII, and PLR. Prespecified subgroup analyses examined effect consistency. Results: = 0.025). RCS analysis revealed a linear positive association between NPAR and mortality. NPAR demonstrated superior discrimination for 30-day mortality (AUC: 0.741) compared with NLR, SII, and PLR. Subgroup analyses yielded consistent associations across prespecified strata with no significant interactions. Conclusions: Elevated admission NPAR is an independent predictor of short-term mortality in AAD. As an easily available and inexpensive biomarker, NPAR may improve early risk stratification and guide clinical decision-making in this high-risk population.