Association Between Naples Prognostic Score and All-Cause Mortality in Individuals with Cardio-Renal-Metabolic Multimorbidity: A Cohort Study.

INTRODUCTION: The Naples Prognostic Score (NPS) has demonstrated prognostic value in oncology and certain chronic diseases. Its utility in cardio-renal-metabolic multimorbidity (CRMM) remains unexplored.

AIM: This study aims to evaluate the association between NPS and all-cause mortality in individuals with CRMM.

METHODS: We analyzed data from the National Health and Nutrition Examination Survey (1999-2018) comprising 3,602 adults with CRMM. The NPS was derived from serum albumin, total cholesterol (TC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Weighted Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to evaluate associations between NPS and all-cause mortality.

RESULTS: Over a median follow-up of 79 months, 1,621 (41.4%) deaths occurred. After comprehensive adjustment for potential confounders, each 1-point increase in NPS was associated with a 24.6% higher risk of all-cause mortality (HR 1.246, 95% CI 1.150-1.350, P < 0.0001). The HRs for all-cause mortality was 1.133 (95 % CI: 0.846-1.518, P = 0.401) in the medium NPS group and 1.721 (95 % CI: 1.248-2.375, P = 0.0009) in the high NPS group, as compared with the low NPS group. RCS analysis indicated a nonlinear relationship between NPS and all-cause mortality among participants with CRMM (Pnonlinear=0.014). Weighted quantile sum regression analysis identified NLR as the primary contributor to mortality risk (weight: 0.612 at 2 years, 0.580 at 5 years), followed by TC.

CONCLUSION: This study identified a positive, nonlinear association between NPS and all-cause mortality in CRMM individuals. The NPS integrates inflammatory, metabolic, and nutritional biomarkers into a practical prognostic tool that may enhance risk stratification and guide personalized management in multimorbidity.