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IMR Press / RCM / Volume 23 / Issue 10 / DOI: 10.31083/j.rcm2310333
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Open Access Original Research
Neutrophil Percentage to Albumin Ratio was Associated with Clinical Outcomes in Coronary Care Unit Patients
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1 Anesthesiology Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, 100029 Beijing, China
2 Anesthesiology Department, Beijing Chaoyang Hospital Affiliated to Capital Medical University, 100020 Beijing, China
3 Cardiology Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, 100029 Beijing, China
*Correspondence: zhaoliyun1007@163.com (Liyun Zhao); wangyun129@ccmu.edu.cn (Yun Wang)
These authors contributed equally.
Rev. Cardiovasc. Med. 2022, 23(10), 333; https://doi.org/10.31083/j.rcm2310333
Submitted: 24 May 2022 | Revised: 26 June 2022 | Accepted: 8 July 2022 | Published: 28 September 2022
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Neutrophil percentage to albumin ratio (NPAR) has been shown to be correlated with the prognosis of various diseases. This study aimed to explore the effect of NPAR on the prognosis of patients in coronary care units (CCU). Method: All data in this study were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III, version1.4) database. All patients were divided into four groups according to their NPAR quartiles. The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality, 365-day mortality, length of CCU stay, length of hospital stay, acute kidney injury (AKI), and continuous renal replacement therapy (CRRT). A multivariate binary logistic regression analysis was performed to confirm the independent effects of NPAR. Cox regression analysis was performed to analyze the association between NPAR and 365-day mortality. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the effect of NPAR on in-hospital mortality in different subgroups. Receiver operating characteristic (ROC) curves were used to evaluate the ability of NPAR to predict in-hospital mortality. Kaplan–Meier curves were constructed to compare the cumulative survival rates among different groups. Result: A total of 2364 patients in CCU were enrolled in this study. The in-hospital mortality rate increased significantly as the NPAR quartiles increased (p $<$ 0.001). In multivariate logistic regression analysis, NPAR was independently associated with in-hospital mortality (quartile 4 versus quartile 1: odds ratio [OR], 95% confidence interval [CI]: 1.83, 1.20–2.79, p = 0.005, p for trend $<$0.001). In Cox regression analysis, NPAR was independently associated with 365-day mortality (quartile 4 versus quartile 1: OR, 95% CI: 1.62, 1.16–2.28, p = 0.005, p for trend $<$0.001). The Lowess curves showed a positive relationship between NPAR and in-hospital mortality. The moderate ability of NPAR to predict in-hospital mortality was demonstrated through ROC curves. The area under the curves (AUC) of NPAR was 0.653 (p $<$ 0.001), which is better than that of the platelet to lymphocyte ratio (PLR) (p $<$ 0.001) and neutrophil count (p $<$ 0.001) but lower than the Sequential Organ Failure Assessment (p = 0.046) and Simplified Acute Physiology Score II (p $<$ 0.001). Subgroup analysis did not reveal any obvious interactions in most subgroups. However, Kaplan–Meier curves showed that as NPAR quartiles increased, the 30-day (log-rank, p $<$ 0.001) and 365-day (log-rank, p $<$ 0.001) cumulative survival rates decreased significantly. NPAR was also independently associated with AKI (quartile 4 versus quartile 1: OR, 95% CI: 1.57, 1.19–2.07, p = 0.002, p for trend = 0.001). The CCU and hospital stay length was significantly prolonged in the higher NPAR quartiles. Conclusions: NPAR is an independent risk factor for in-hospital mortality in patients in CCU and has a moderate ability to predict in-hospital mortality.

Keywords
coronary care unit
neutrophil percentage to albumin ratio
in-hospital mortality
acute kidney injury
predictive ability
Funding
2018YFC2001900-02/National Key R&D Program of China
ZYLX201810/Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support
Figures
Fig. 1.
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