Frontiers in medicine · 2026
High neutrophil-to-albumin ratio signals severe prognosis in LVO stroke-data from an EICU cohort.
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Yang Chao, Wang Jingying, Lu Yiyao, Xu Yinghe, Jiang Yongpo, Zhao Hui
Аннотация
OBJECTIVE: To investigate whether the neutrophil-to-albumin ratio (NPAR) predicts adverse outcomes in acute large vessel occlusion (LVO) stroke.
METHODS: This cohort study enrolled 893 LVO stroke patients (2021-2023). Associations between NPAR and outcomes were assessed using logistic regression, restricted cubic spline, and ROC analysis.
RESULTS: Higher NPAR correlated with elevated NIHSS, inflammatory markers, coagulation parameters, and dysphagia, and decreased hemoglobin, lymphocytes, and GCS. NPAR was an independent predictor for 90-day poor functional outcome (OR = 1.10, 95%CI: 1.07-1.14), pneumonia (OR = 1.14, 95%CI: 1.10-1.18), and intracerebral hemorrhage (ICH) (OR = 1.06, 95%CI:1.03-1.10). After multivariable adjustment, associations remained robust (aOR: 1.06-1.14). Linear dose-response relationships were observed. NPAR showed modest predictive performance (AUC: 0.60-0.65). Adding NPAR significantly improved pneumonia prediction over AIS-APS (AUC: 0.684 → 0.709, p = 0.0049), enhanced ICH sensitivity (56.6% → 64.6%), but minimally improved 90-day outcome prediction.
CONCLUSION: Elevated NPAR independently predicts pneumonia, ICH, and poor functional recovery in LVO stroke, serving as a potential early risk stratification tool. However, these findings should be interpreted in light of the study's limitations, including its single-center retrospective design, single time-point NPAR measurement, and predominantly Han Chinese population, which may limit generalizability.
METHODS: This cohort study enrolled 893 LVO stroke patients (2021-2023). Associations between NPAR and outcomes were assessed using logistic regression, restricted cubic spline, and ROC analysis.
RESULTS: Higher NPAR correlated with elevated NIHSS, inflammatory markers, coagulation parameters, and dysphagia, and decreased hemoglobin, lymphocytes, and GCS. NPAR was an independent predictor for 90-day poor functional outcome (OR = 1.10, 95%CI: 1.07-1.14), pneumonia (OR = 1.14, 95%CI: 1.10-1.18), and intracerebral hemorrhage (ICH) (OR = 1.06, 95%CI:1.03-1.10). After multivariable adjustment, associations remained robust (aOR: 1.06-1.14). Linear dose-response relationships were observed. NPAR showed modest predictive performance (AUC: 0.60-0.65). Adding NPAR significantly improved pneumonia prediction over AIS-APS (AUC: 0.684 → 0.709, p = 0.0049), enhanced ICH sensitivity (56.6% → 64.6%), but minimally improved 90-day outcome prediction.
CONCLUSION: Elevated NPAR independently predicts pneumonia, ICH, and poor functional recovery in LVO stroke, serving as a potential early risk stratification tool. However, these findings should be interpreted in light of the study's limitations, including its single-center retrospective design, single time-point NPAR measurement, and predominantly Han Chinese population, which may limit generalizability.