Changjing Shi,1,* Juan Wang,2,* Weichen Liu,2 Yiyi Mo,2 Yuan Huang,2 Xiaoxiao Wei,2 Dongmei Huo,2,* Aifang Huang2,* 

1Information Technology Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China; 2Department of Blood Purification, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Aifang Huang, Department of Blood Purification, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China, Email YFY003433@sr.gxmu.edu.cn

Introduction: Neutrophil percentage-to-albumin ratio (NPAR), dually reflecting inflammation and malnutrition, is related to poor prognosis closely in a range of diseases. However, prognostic value of NPAR in maintenance hemodialysis (MHD) patients remains to be confirmed. This study aimed to investigate the association between NPAR and all-cause mortality in MHD patients.
Methods: Patients undergoing maintenance hemodialysis in the blood purification department of The First Affiliated Hospital of Guangxi Medical University from January 2021 to June 2021 were prospectively studied. NPAR was calculated by dividing neutrophils percentage by Albumin. Participants were followed for 36 months, with all-cause mortality as the primary endpoint.
Results: There were 146 male and 80 female MHD patients included in this study, with a median age of 56 years. 53 (23.5%) patients died during the follow-up period. Kaplan–Meier (K–M) analysis revealed significantly lower survival in patients with high NPAR (> 16.96) compared to those with low NPAR (≤ 16.96) (log rank test p=0.000). Multivariate Cox regression has identified NPAR as an independent predictor of all-cause mortality (HR=1.346, 95% CI 1.192– 1.521, p=0.000). Receiver operating characteristic (ROC) analysis demonstrated that the Area Under the Curve (AUC) of NPAR was 0.821 (95% CI: 0.759– 0.882, p=0.000) and had a trend to be better than that of neutrophil-to-lymphocyte ratio (NLR; AUC=0.710), platelet-to-lymphocyte ratio (PLR; AUC=0.647), neutrophil count (AUC=0.606), albumin (ALB; AUC=0.752), and high-sensitivity C-reactive protein (hs-CRP; AUC=0.670).
Conclusion: NPAR is independently associated with all-cause mortality in MHD patients and may serve as an emerging indicator for risk stratification and prognostic management for this group of patients.

Keywords: hemodialysis, neutrophil percentage-to-albumin ratio, mortality