Association between neutrophil percentage-to-albumin ratio and neutrophil-to-albumin ratio with long-term mortality in patients with intracerebral hemorrhage

Sen Zhang; Yangchun Xiao; Xiang Yuan; Quanhu Guo; Yuyang Liu; Jun Wan; Peng Wang; Cuyubamba Dominguez Jorge Luis; Shijie Fan; Hao Liu; Yikang Ouyang; Qiaoyu You; Fang Fang; Yu Zhang

doi:10.1016/j.wneu.2025.124279

Association between neutrophil percentage-to-albumin ratio and neutrophil-to-albumin ratio with long-term mortality in patients with intracerebral hemorrhage

World Neurosurg. 2025 Jul 11:124279. doi: 10.1016/j.wneu.2025.124279. Online ahead of print.

Authors

Sen Zhang¹, Yangchun Xiao¹, Xiang Yuan¹, Quanhu Guo², Yuyang Liu³, Jun Wan⁴, Peng Wang⁵, Cuyubamba Dominguez Jorge Luis⁶, Shijie Fan⁷, Hao Liu⁷, Yikang Ouyang⁷, Qiaoyu You⁷, Fang Fang⁵, Yu Zhang⁸

Affiliations

¹ Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China; Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
² Department of Neurosurgery, Shanxi Medical University Fenyang College, Fenyang, Shanxi.
³ Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China; Center for Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
⁴ Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China; Clinical Medical College, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
⁵ Department of Neurosurgery, West Hospital of China, Chengdu, Sichuan, China.
⁶ Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, China.
⁷ Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
⁸ Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China. Electronic address: zhangyu1057@cdu.edu.cn.

PMID: 40653015
DOI: 10.1016/j.wneu.2025.124279

Abstract

Background: 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.

Methods: We conducted a retrospective cohort study, including patients diagnosed with ICH from two 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 (ROC) analysis were created.

Results: A total of 3,350 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 HR 2.15, 95% CI: 1.78-2.59; NAR Q4 vs. Q1: adjusted HR 1.82, 95% CI: 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.

Conclusion: 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.

Keywords: Intracerebral hemorrhage; Long-term mortality; Neutrophil percentage-to-albumin ratio; Neutrophil-to-albumin ratio.