Association Between Neutrophil Percentage-to-Albumin Ratio and Neutrophil-to-Albumin Ratio with Long-Term Mortality in Patients with Intracerebral Hemorrhage.

Abstract

The association between the neutrophil percentage-to-albumin ratio (NPAR) and neutrophil-to-albumin ratio (NAR) with long-term mortality in patients with intracerebral hemorrhage (ICH) remains underexplored. We conducted a retrospective cohort study, including patients diagnosed with ICH from 2 tertiary care centers. NPAR and NAR levels were calculated from blood samples obtained within 24 hours of admission. The primary outcome was long-term mortality, defined as mortality at the longest available follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the associations. To demonstrate the predictive performance of different biomarkers over time, time-dependent receiver operating characteristic curve analysis was created. A total of 3350 patients with ICH were included in this study. Higher quartiles of the NPAR and NAR were associated with increased long-term mortality. Multivariate Cox regression analysis revealed that patients in the highest quartile of NPAR and NAR had substantially higher mortality risks compared to those in the lowest quartile (NPAR Q4 vs. Q1: adjusted hazard ratio: 2.15, 95% confidence interval: 1.78-2.59; NAR Q4 vs. Q1: adjusted hazard ratio: 1.82, 95% confidence interval: 1.52-2.18). Similar associations were observed for in-hospital mortality, 1-year mortality, and long-term mortality among discharge and 1-year survivors. The prognostic performance of NPAR was continuously superior to other inflammatory biomarkers. Our study demonstrates that NPAR and NAR are significant predictors of long-term mortality in ICH patients. Incorporating these biomarkers into clinical practice may improve risk stratification and outcomes.