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<p>The neutrophil percentage-to-albumin ratio (NPAR) has emerged as a biomarker for systemic inflammation; however, its association with the prognosis of IgA nephropathy (IgAN) remains unclear. In this retrospective cohort study, we aimed to evaluate the relationship between NPAR and IgAN and enrolled 389 patients with biopsy-proven primary IgAN treated at the Affiliated Hospital of Chengde Medical University between January 2013 and July 2024. Baseline demographic, clinical, and pathological data were collected. The NPAR was calculated as neutrophil percentage (NEUT%) × 100 / albumin (g/dL). The optimal cut-off value of the NPAR for predicting end-stage renal disease (ESRD) was determined using receiver operating characteristic (ROC) curve analysis; the patients were divided into high and low NPAR groups accordingly. The ROC curve showed that the optimal cut-off value of the NPAR for predicting ESRD was 18.54, with an area under the curve of 0.670 (sensitivity 55.3%, specificity 74.6%). Patients in the high NPAR group were significantly older and had a higher prevalence of anemia, as well as higher NEUT%, 24-h UPE, and incidence of ESRD, whereas eGFR and albumin levels were significantly lower (all <i>P</i> &lt; 0.05); pathologically, they were more prone to endocapillary hypercellularity (E1) and tubular atrophy/interstitial fibrosis (T1-2) (<i>P</i> &lt; 0.05). Correlation analysis showed that the NPAR was positively correlated with age, anemia, 24-hour urine protein, E lesion, and T lesion, and negatively correlated with eGFR (all <i>P</i> &lt; 0.05). Multivariate Cox regression analysis demonstrated that an NPAR ≥ 18.54 was an independent risk factor for progression to ESRD in IgAN patients (HR = 2.176, 95%CI: 1.058～4.472, <i>P</i> = 0.034). Subgroup analysis showed that NPAR demonstrated a consistent prognostic discriminative trend across most subgroups, whereas no significant predictive effect was observed in the M0 subtype. Restricted cubic splines (RCS) suggested a linear positive correlation between NPAR and ESRD risk (<i>P</i> for non-linearity = 0.5569). An elevated NPAR is independently associated with severe clinicopathological features and poor renal prognosis in patients with IgAN. As a convenient and cost-effective inflammatory marker, given its limited discriminative ability (AUC = 0.670), NPAR can only serve as an auxiliary reference in clinical assessment, and its practical value requires further external validation.</p>

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Prognostic value of the neutrophil percentage-to-albumin ratio in patients with IgA nephropathy

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  • 发表日期：

    2026年7月29日

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  • Shuo Li,
  • Yan Huang,
  • Meiran Cao,
  • Jingfu Wang

摘要

The neutrophil percentage-to-albumin ratio (NPAR) has emerged as a biomarker for systemic inflammation; however, its association with the prognosis of IgA nephropathy (IgAN) remains unclear. In this retrospective cohort study, we aimed to evaluate the relationship between NPAR and IgAN and enrolled 389 patients with biopsy-proven primary IgAN treated at the Affiliated Hospital of Chengde Medical University between January 2013 and July 2024. Baseline demographic, clinical, and pathological data were collected. The NPAR was calculated as neutrophil percentage (NEUT%) × 100 / albumin (g/dL). The optimal cut-off value of the NPAR for predicting end-stage renal disease (ESRD) was determined using receiver operating characteristic (ROC) curve analysis; the patients were divided into high and low NPAR groups accordingly. The ROC curve showed that the optimal cut-off value of the NPAR for predicting ESRD was 18.54, with an area under the curve of 0.670 (sensitivity 55.3%, specificity 74.6%). Patients in the high NPAR group were significantly older and had a higher prevalence of anemia, as well as higher NEUT%, 24-h UPE, and incidence of ESRD, whereas eGFR and albumin levels were significantly lower (all P < 0.05); pathologically, they were more prone to endocapillary hypercellularity (E1) and tubular atrophy/interstitial fibrosis (T1-2) (P < 0.05). Correlation analysis showed that the NPAR was positively correlated with age, anemia, 24-hour urine protein, E lesion, and T lesion, and negatively correlated with eGFR (all P < 0.05). Multivariate Cox regression analysis demonstrated that an NPAR ≥ 18.54 was an independent risk factor for progression to ESRD in IgAN patients (HR = 2.176, 95%CI: 1.058～4.472, P = 0.034). Subgroup analysis showed that NPAR demonstrated a consistent prognostic discriminative trend across most subgroups, whereas no significant predictive effect was observed in the M0 subtype. Restricted cubic splines (RCS) suggested a linear positive correlation between NPAR and ESRD risk (P for non-linearity = 0.5569). An elevated NPAR is independently associated with severe clinicopathological features and poor renal prognosis in patients with IgAN. As a convenient and cost-effective inflammatory marker, given its limited discriminative ability (AUC = 0.670), NPAR can only serve as an auxiliary reference in clinical assessment, and its practical value requires further external validation.