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Background <p>The neutrophil percentage-to-albumin ratio (NPAR) has been linked to outcomes in cardiovascular disease, yet its prognostic value in cerebral infarction (CI) remains unknown. This study investigates the association between NPAR and all-cause mortality in critically ill CI patients.</p> Methods <p>Data from 2338 CI patients (MIMIC-IV database) were stratified into NPAR tertiles (T1: &lt; 20.975, T2: 20.975–26.888, and T3: ≥ 26.888). Primary endpoints included ICU, 30-, 90-, and 365-day mortality. Survival analysis used Kaplan–Meier curves and multivariable Cox regression. Restricted cubic splines (RCS) tested nonlinear associations, and subgroup analyses assessed consistency across clinical subgroups.</p> Results <p>Mortality rates were 12.45% (ICU), 25.15% (30 days), 33.40% (90 days), and 43.54% (365 days). Higher NPAR was associated with worse survival (all log-rank <i>p</i> &lt; 0.001). Adjusted Cox models showed T3 vs. T1 increased 30-day, 90-day, and 365-day mortality risk. RCS revealed nonlinear relationships (<i>P</i>-nonlinearity &lt; 0.01), with an inflection point at NPAR = 23.6. Subgroup analyses showed consistent associations across sex, comorbidities, and severity scores, except age, which modified ICU mortality risk.</p> Conclusions <p>Higher NPAR levels are independently associated with increased short- and long-term all-cause mortality in critically ill CI patients. NPAR may serve as a practical and accessible prognostic marker for risk stratification in the ICU.</p>

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Neutrophil-to-albumin ratio and all-cause mortality in critically ill patients with cerebral infarction: a retrospective cohort study using the MIMIC-IV database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月2日

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  • Zixiang Xu,
  • Sisi Qin,
  • Qile Jin,
  • Yunjie Huo,
  • Liangqun Rong,
  • Xiu’e Wei,
  • Haiyan Liu,
  • Cuicui Zhang,
  • Caiyi Zhang,
  • Shiqi Yuan,
  • Dunjing Wang

摘要

Background

The neutrophil percentage-to-albumin ratio (NPAR) has been linked to outcomes in cardiovascular disease, yet its prognostic value in cerebral infarction (CI) remains unknown. This study investigates the association between NPAR and all-cause mortality in critically ill CI patients.

Methods

Data from 2338 CI patients (MIMIC-IV database) were stratified into NPAR tertiles (T1: < 20.975, T2: 20.975–26.888, and T3: ≥ 26.888). Primary endpoints included ICU, 30-, 90-, and 365-day mortality. Survival analysis used Kaplan–Meier curves and multivariable Cox regression. Restricted cubic splines (RCS) tested nonlinear associations, and subgroup analyses assessed consistency across clinical subgroups.

Results

Mortality rates were 12.45% (ICU), 25.15% (30 days), 33.40% (90 days), and 43.54% (365 days). Higher NPAR was associated with worse survival (all log-rank p < 0.001). Adjusted Cox models showed T3 vs. T1 increased 30-day, 90-day, and 365-day mortality risk. RCS revealed nonlinear relationships (P-nonlinearity < 0.01), with an inflection point at NPAR = 23.6. Subgroup analyses showed consistent associations across sex, comorbidities, and severity scores, except age, which modified ICU mortality risk.

Conclusions

Higher NPAR levels are independently associated with increased short- and long-term all-cause mortality in critically ill CI patients. NPAR may serve as a practical and accessible prognostic marker for risk stratification in the ICU.