Association Between Neutrophil Percentage-to-Albumin Ratio and All-Cause Mortality and Cardiovascular Events in...

Patients with diabetes-related foot ulcers (DFU) face a significantly elevated risk of cardiovascular events and mortality. The neutrophil percentage-to-albumin ratio (NPAR), as a composite inflammatory-nutritional biomarker, has not been thoroughly evaluated for its association with all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE) in the DFU population.

To investigate the association between baseline NPAR levels and all-cause mortality, cardiovascular mortality, as well as MACE in patients with DFU.

This study enrolled 1175 patients diagnosed with DFU. Based on baseline NPAR quartiles, participants were categorized into four groups: Q1, Q2, Q3, and Q4. Multivariable Cox proportional hazards regression models were employed to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI). The associations between NPAR and the endpoint events were evaluated using subgroup analyses, Kaplan-Meier curves, and restricted cubic spline models, while the mediating role of eGFR was also examined.

During a median follow-up of 3.6 years, a total of 360 all-cause deaths (30.64%), 236 cardiovascular deaths (20.09%), and 323 MACE (27.49%) were recorded. Multivariable-adjusted Cox proportional hazards regression analysis revealed that a per-unit increment in NPAR was associated with a 5% higher hazard of all-cause mortality and MACE, and a 6% higher hazard of cardiovascular mortality. Compared with the Q1 group, the Q4 group of NPAR demonstrated significantly higher risks of all-cause mortality (HR = 1.85), cardiovascular mortality (HR = 1.06), and MACE (HR = 1.05), with all p-values < 0.001. A piecewise regression model revealed that the saturation thresholds for these associations were identified at NPAR values of 20.2, 19.9, and 23.3, respectively. The mediating effects of eGFR accounted for 11.7%, 7.3%, and 8.7% of the total effects on all-cause mortality, cardiovascular mortality, and MACE, respectively.

Elevated NPAR levels significantly increase the risk of all-cause mortality, cardiovascular mortality, and MACE in patients with DFU.