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Background <p>Systemic inflammation and immune dysregulation may be associated with asthma onset and progression. Neutrophil percentage-to-albumin ratio (NPAR) is a novel marker of systemic inflammation. We aimed to investigate the association of NPAR with all-cause and respiratory disease-related mortality in adults with asthma.</p> Methods <p>This is a retrospective cohort study using data from 5032 participants with asthma from the National Health and Nutrition (NHANES) spanning from 1999 to 2018. NPAR was calculated by neutrophil percentage (% of total white blood cell count) × 100/serum albumin (g/dl). Asthma was self-reported based on responses to a standardized questionnaire in NHANES. Mortality data were obtained through retrospective matching with the National Death Index (NDI), using secondary data from NHANES. Survey-weighted multivariable Cox proportional hazards regression analysis was used to explore these associations.</p> Results <p>After a median follow-up duration of 104 months, 696 participants died, of which 101 were respiratory disease-related deaths. In fully adjusted models, NPAR was significantly and positively associated with both all-cause and respiratory disease-related mortality (hazard ratios [HR] of 1.13 and 1.25, respectively, both <i>p</i> &lt; 0.0001). Compared to Q1, NPAR at Q4 was associated with significantly increased all-cause and respiratory disease-related mortality (all-cause: HR 2.23, <i>p</i> &lt; 0.0001; respiratory disease-related: HR 3.55, <i>p</i> = 0.004). NPAR was nonlinearly associated with all-cause mortality, with an inflection point of 13.76. This association was significant only after the inflection point (HR 1.18, <i>p</i> &lt; 0.0001). The effect of NPAR on all-cause mortality was more pronounced in those &lt; 60 years of age (HR 1.19, <i>p</i> &lt; 0.0001).</p> Conclusions <p>Higher NPAR was associated with increased all-cause and respiratory disease-related mortality in US adults with asthma. Further exploration of the prognostic potential and underlying mechanisms of NPAR is needed.</p> Clinical trial number <p>Not applicable.</p>

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Association of neutrophil percentage-to-albumin ratio with all-cause and respiratory disease-related mortality in US adults with asthma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月3日

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  • Dan Wang,
  • Rui Su,
  • Ruina Li,
  • Xiaofeng Li,
  • Hui Zhao

摘要

Background

Systemic inflammation and immune dysregulation may be associated with asthma onset and progression. Neutrophil percentage-to-albumin ratio (NPAR) is a novel marker of systemic inflammation. We aimed to investigate the association of NPAR with all-cause and respiratory disease-related mortality in adults with asthma.

Methods

This is a retrospective cohort study using data from 5032 participants with asthma from the National Health and Nutrition (NHANES) spanning from 1999 to 2018. NPAR was calculated by neutrophil percentage (% of total white blood cell count) × 100/serum albumin (g/dl). Asthma was self-reported based on responses to a standardized questionnaire in NHANES. Mortality data were obtained through retrospective matching with the National Death Index (NDI), using secondary data from NHANES. Survey-weighted multivariable Cox proportional hazards regression analysis was used to explore these associations.

Results

After a median follow-up duration of 104 months, 696 participants died, of which 101 were respiratory disease-related deaths. In fully adjusted models, NPAR was significantly and positively associated with both all-cause and respiratory disease-related mortality (hazard ratios [HR] of 1.13 and 1.25, respectively, both p < 0.0001). Compared to Q1, NPAR at Q4 was associated with significantly increased all-cause and respiratory disease-related mortality (all-cause: HR 2.23, p < 0.0001; respiratory disease-related: HR 3.55, p = 0.004). NPAR was nonlinearly associated with all-cause mortality, with an inflection point of 13.76. This association was significant only after the inflection point (HR 1.18, p < 0.0001). The effect of NPAR on all-cause mortality was more pronounced in those < 60 years of age (HR 1.19, p < 0.0001).

Conclusions

Higher NPAR was associated with increased all-cause and respiratory disease-related mortality in US adults with asthma. Further exploration of the prognostic potential and underlying mechanisms of NPAR is needed.

Clinical trial number

Not applicable.