# Neutrophil-to-albumin ratio predicts long-term prognosis in coronary heart disease: a prospective cohort study of 2,990 patients

## TL;DR

The study shows that a blood test measuring neutrophil-to-albumin ratio (NPAR) can predict long-term heart risks in patients with coronary disease.

## Contribution

This is the first study to establish NPAR as an independent predictor of major adverse cardiovascular events in hospitalized coronary heart disease patients.

## Key findings

- Patients with the highest NPAR had a 72% increased risk of MACE compared to those with the lowest NPAR.
- A J-shaped relationship was observed, with risk increasing sharply above an NPAR of 17.
- Males in the highest NPAR tertile had a more than doubled risk of MACE.

## Abstract

Cardiovascular diseases (CVDs), particularly coronary heart disease (CHD), impose a global health burden with unpredictable major adverse cardiovascular events (MACE) despite optimal treatment. Systemic inflammation and malnutrition are key pathogenic drivers, yet integrated biomarkers capturing this duality are lacking. The Neutrophil-to-Albumin Ratio (NPAR) emerges as a cost-effective indicator reflecting both pathways, but its prognostic value for post-discharge MACE in hospitalized CHD patients remains unestablished. Our study aimed at investigating the prognostic value of NPAR for MACE in CHD patients.

This prospective cohort study enrolled CHD patients (2013–2020) from the First Affiliated Hospital of Xi’an Jiaotong University. NPAR was calculated from admission blood samples. Participants were stratified into NPAR tertiles (T1: 5.21–16.00; T2: 16.01–18.50; T3: 18.51–42.38). Multivariable Cox models (adjusting for demographics, comorbidities, and laboratory parameters) assessed NPAR-MACE associations. Restricted cubic splines (RCS) and subgroup analyses explored nonlinearity and effect modifiers.

A total of 2,990 patients with CHD were eligible for analysis. With a median follow-up of 70 months, Kaplan–Meier survival curves demonstrated that participants in the highest NPAR tertile (T3) exhibited significantly lower cumulative survival rates free from MACE compared to those in the lowest tertile (T1). The highest NPAR tertile (T3) exhibited a 72% increased MACE risk (adjusted hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.36–2.20) versus T1. A J-shaped relationship emerged, with risk escalating above NPAR = 17 (P nonlinear = 0.01). Sex-specific heterogeneity was observed: males in T3 had markedly elevated risk (HR = 2.03, 95% CI: 1.50–2.75; P interaction = 0.03).

Elevated admission NPAR independently predicts long-term MACE in CHD patients, particularly among males. This supports NPAR’s utility for post-discharge risk stratification.

Admission NPAR independently predicts long-term MACE in CHD patients. Graphical abstract demonstrates the strong clinical predictive performance of the neutrophil-to-albumin ratio (NPAR) for long-term major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD) after discharge. Created in BioRender. Xie, Y. (2025) https://BioRender.com/4ismqah.Illustration of coronary heart disease progression and analysis. A person holds their chest, indicating heart disease, with diagrams of arterial plaque and blood indicators suggesting inflammatory markers. Arrows point to potential outcomes: stroke, myocardial infarction (MI), and cardiac death. A survival analysis chart titled "MACE in the long-term prognosis" with three colored survival curves and an RCS curve showing hazard ratios with confidence intervals. The graphic explores how inflammatory markers predict major adverse cardiac events (MACE) over time.

Admission NPAR independently predicts long-term MACE in CHD patients. Graphical abstract demonstrates the strong clinical predictive performance of the neutrophil-to-albumin ratio (NPAR) for long-term major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD) after discharge. Created in BioRender. Xie, Y. (2025) https://BioRender.com/4ismqah.