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Background <p>This study investigates the association between the neutrophil percentage-to-albumin ratio (NPAR) and mortality in takotsubo syndrome (TS) patients.</p> Methods <p>We conducted a retrospective cohort study using data from the MIMIC-IV version 3.1 database. Multivariable Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the associations between NPAR and 28-day, 180-day, and 365-day mortality. Predictive performance for 28-day mortality was assessed using receiver operating characteristic (ROC) analysis and seven machine-learning models.</p> Results <p>A total of 201 patients with TS were included. Higher NPAR was independently associated with increased 28-day mortality (HR 5.494, 95% CI 1.939–12.190, <i>P</i> &lt; 0.001), 180-day mortality (HR 5.141, 95% CI 2.367–11.166, <i>P</i> &lt; 0.001), and 365-day mortality (HR 5.280, 95% CI 2.439–11.429, <i>P</i> &lt; 0.001). RCS analysis showed a significant overall association between NPAR and 28-day mortality (P for overall = 0.041), without significant nonlinearity (P for nonlinear = 0.194). NPAR showed modest predictive ability for 28-day mortality (AUC 0.640). In machine-learning analyses, NPAR was identified as an important prognostic feature, and the random forest model achieved the highest AUC (0.771).</p> Conclusions <p>Higher NPAR values are associated with increased mortality rates at 28-day, 180-day, and 365-day intervals in TS patients, suggesting NPAR as a potential predictive marker for TS outcomes.</p>

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Association between neutrophil percentage to albumin ratio and mortality in takotsubo syndrome patients: analysis of the MIMIC-IV database

  • 期刊论文

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  • 发表日期：

    2026年5月25日

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  • Chongzhe Pei,
  • Kuan Yang,
  • Xin Ding,
  • Hongshi Li,
  • Li Xue,
  • Hongmei Zheng,
  • Heng Cai

摘要

Background

This study investigates the association between the neutrophil percentage-to-albumin ratio (NPAR) and mortality in takotsubo syndrome (TS) patients.

Methods

We conducted a retrospective cohort study using data from the MIMIC-IV version 3.1 database. Multivariable Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the associations between NPAR and 28-day, 180-day, and 365-day mortality. Predictive performance for 28-day mortality was assessed using receiver operating characteristic (ROC) analysis and seven machine-learning models.

Results

A total of 201 patients with TS were included. Higher NPAR was independently associated with increased 28-day mortality (HR 5.494, 95% CI 1.939–12.190, P < 0.001), 180-day mortality (HR 5.141, 95% CI 2.367–11.166, P < 0.001), and 365-day mortality (HR 5.280, 95% CI 2.439–11.429, P < 0.001). RCS analysis showed a significant overall association between NPAR and 28-day mortality (P for overall = 0.041), without significant nonlinearity (P for nonlinear = 0.194). NPAR showed modest predictive ability for 28-day mortality (AUC 0.640). In machine-learning analyses, NPAR was identified as an important prognostic feature, and the random forest model achieved the highest AUC (0.771).

Conclusions

Higher NPAR values are associated with increased mortality rates at 28-day, 180-day, and 365-day intervals in TS patients, suggesting NPAR as a potential predictive marker for TS outcomes.