Related Experiment Video
Updated: Sep 30, 2026
Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
Published on: November 27, 2019
Association of NPAR with 90-day mortality in predominantly acute-on-chronic liver failure
Jiahua Hu1, Lu Li1, Xiaoli Yang1
1Department of Infectious Diseases, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Background:
Acute-on-chronic liver failure (ACLF) carries high short-term mortality, and easily available prognostic biomarkers are urgently needed. The neutrophil percentage-to-albumin ratio (NPAR) integrates inflammatory and nutritional status, but its prognostic value in liver failure remains unclear. This study aimed to investigate the association between NPAR and 90-day mortality in patients with liver failure, hypothesizing that elevated NPAR would be associated with worse outcomes.
Methods:
This retrospective cohort study included 104 adult patients with liver failure (89.4% ACLF) admitted from January 2022 to December 2024. NPAR was calculated as neutrophil percentage divided by albumin concentration. The primary outcome was 90-day mortality. We used log-transformed NPAR in regression analyses to improve model stability. Multivariable logistic regression was performed with MELD score as the sole covariate in a parsimonious two-predictor model, with bootstrap validation (1,000 iterations). Formal tests for interaction were conducted to assess potential effect modification by sex, age (<60 vs. ≥60 years), and ascites status.
Results:
Of 104 patients, 29 (27.9%) died within 90 days. The non-survival group had significantly higher NPAR levels [median 2.51 (IQR: 2.17-2.82) vs. 1.88 (1.61-2.29), P < 0.001]. In univariate analysis, log-transformed NPAR was associated with mortality (OR: 2.67 per 1-unit increase in ln-NPAR, 95% CI: 1.04-6.86, P = 0.041). After adjustment for MELD score, the association was attenuated and no longer statistically significant (adjusted OR: 1.66, 95% CI: 0.40-6.82, P = 0.484). Bootstrap validation confirmed the instability of the adjusted estimate (median OR: 1.64, 95% CI: 0.45-9.73). Tests for interaction showed no significant effect modification by sex (P-interaction = 0.393), age (P-interaction = 0.419), or ascites status (P-interaction = 0.799).
Conclusions:
After adjustment for MELD score, no statistically significant independent association was demonstrated between ln-NPAR and 90-day mortality (adjusted OR: 1.66, 95% CI: 0.40-6.82). Whether NPAR provides incremental prognostic information beyond established severity scores remains to be determined in larger studies. These findings primarily apply to a predominantly ACLF population.
