Neutrophil-Percentage-to-Albumin Ratio and Monocyte-to-Albumin Ratio: Utility of the Combined Biomarkers in the Prediction of 30-Day Mortality in Male Diabetes Patients Over 80 Years Old with Bloodstream Infections

Shan Qin,1,* Nan Li,1,* Yu Zhou,2,* Yan Zhang,3 Zhenghao Yu,4,5 Xinran Liu,4,5 Jianbo Zhong,4,5 Chuanbin Liu,4 Pinzheng Zhang,6 Changbai Pei,4 Xinjie Han,5 Pingjun Zhu,7 Yingzhen Du,6 Guogang Xu4 1Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Clinical Laboratory, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China; 3Department of Health Care, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China; 4Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China; 5Health Management Institute, Medical School of Chinese PLA, Beijing, People’s Republic of China; 6Department of Disease Control and Prevention, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China; 7Department of Respiratory and Critical Care Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guogang Xu, Email [email protected] Yingzhen Du, Email [email protected]: Elderly patients with diabetes mellitus (DM) are highly vulnerable to bloodstream infections (BSI), which lead to a significantly high risk of mortality. Novel inflammatory markers that attach to albumin, such as Neutrophil-percentage-to-albumin ratio (NPAR), C-reactive protein-to-albumin ratio (CAR), Monocyte-to-albumin ratio (MAR), Red blood cell distribution width-to-albumin ratio (RAR), Prognostic Nutritional Index (PNI) and C-reactive protein-albumin-lymphocyte index (CALLY index), have proven to be effective in predicting infections. However, the association between these factors and BSI in diabetes patients over 80 years old still remains to be fully elucidated.Purpose: To investigate the predictive value of the novel inflammatory markers NPAR, CAR, MAR, RAR, PNI and CALLY index for the prognosis in male diabetes patients over 80 years old with bloodstream Infections of 30-day mortality.Patients and Methods: Male diabetes patients over 80 years old who diagnosed with BSI were recruited between January 2012 and January 2025. Receiver operating characteristic (ROC) curves, Kaplan-Meier curves (K-M curves) and Cox regression analysis were used to investigate the association between these factors and 30-day mortality.Results: A total of 350 diabetes patients with BSI were recruited in the study, with an average age of 89.77± 8.62 years. There are 55 deaths within 30 days, with an all-cause mortality rate of 15.71%. After adjusting for multiple factors, the NPAR2 and MAR2 groups still correlated with 30 days mortality. (NPAR2 HR, 95% CI: 2.738, 1.058– 7.084, P= 0.038; MAR2 HR, 95% CI: 1.871, 1.012– 3.458, P=0.046). The CAR, RAR, PNI and the CALLY index showed no significant differences in COX regression.Conclusion: NPAR and MAR are more sensitive markers in male diabetes patients over 80 years old with BSI and can provide a reference for predicting 30-day mortality in patients with BSI.Keywords: inflammatory markers, neutrophil percentage-to-albumin ratio, monocyte-to-albumin ratio, bloodstream infections, elder, mortality