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Association between neutrophil percentage-to-albumin ratio and chronic subdural hematoma: a retrospective
Guanda Han1, Yifan Lv1, Mingjie Wang1
1Department of Neurosurgery at the First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
Objective:
To investigate the association between neutrophil percentage-to-albumin ratio (NPAR) and chronic subdural hematoma (CSDH), and evaluate its discriminative efficacy.
Methods:
Clinical data of 87 CSDH patients and 130 healthy controls (2023-2025) were retrospectively analyzed. Logistic regression, ROC curves, bootstrap validation (1,000 iterations), VIF, and Hosmer-Lemeshow test were performed. Stratified analyses by age (<70 vs. ≥70 years) and sex assessed association robustness.
Results:
NPAR was significantly higher in CSDH patients (15.31 ± 2.71 vs. 12.47 ± 1.97, P < 0.001). Multivariate analysis showed NPAR (OR = 1.88, 95% CI: 1.41-2.51, P < 0.001), age, male sex, and lipids were independently associated with CSDH. NPAR demonstrated optimal discriminative efficacy (AUC = 0.808, 95% CI: 0.747-0.868; cutoff 14.18; sensitivity 71.3%; specificity 83.8%). Bootstrap-validated multivariate AUC was 0.914 (optimism-corrected 0.907). In age-balanced strata, NPAR remained significantly higher in CSDH (male <70 years: P < 0.001; female ≥70 years: P < 0.05). Progressive adjustment attenuated the NPAR OR by only 9.6% (from 1.768 to 1.605), with full adjustment yielding OR = 1.626 (95% CI: 1.238-2.135). VIF < 5; Hosmer-Lemeshow P = 0.072.
Conclusion:
NPAR showed a significant independent association with CSDH. As a simple, economical inflammation-nutrition composite indicator, it may aid CSDH risk assessment. However, this association cannot be directly extrapolated as a clinically operational diagnostic threshold, warranting validation in target screening populations.