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

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.

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.

Higher NPAR values were independently associated with increased 30-day mortality (adjusted OR: 1.48; 95% CI: 1.05-2.09; P = 0.027). Patients in the highest NPAR tertile (≥22.37) had significantly greater mortality risk than those in the lowest tertile (<19.95) (adjusted OR: 20.28; 95% CI: 1.45-283.0; P = 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.

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.