Frontiers in nutrition · 2026
Association of neutrophil-to-prognostic nutritional index ratio with long-term mortality in acute myocardial infarction from Chinese and US cohorts.
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Li Hongqiang, Luo Jiachen, Li Gang, Yang Fei, Wang Zhenhua, Wei Yidong
Аннотация
BACKGROUND: Despite advancements in reperfusion strategies, patients with acute myocardial infarction (AMI) face significant risks of long-term mortality. Systemic inflammation and nutritional/immune depletion synergistically impact prognosis. This study investigated the prognostic value of the neutrophil count to prognostic nutritional index ratio (NPNR)-a novel composite index reflecting inflammatory burden and nutritional reserves-in AMI patients.
METHODS: This dual-cohort study included 2020 patients from the NOAFCAMI-SH registry in China and 1,433 patients from the MIMIC-IV database in the USA. The primary endpoint was all-cause mortality; the secondary endpoint was cardiovascular mortality. Associations were analyzed using Kaplan-Meier curves, Cox regression, and restricted cubic splines.
RESULTS: During a median 2.5-year follow-up in the discovery cohort, 285 all-cause and 234 cardiovascular deaths occurred. Higher NPNR levels correlated with myocardial injury and lower LVEF. Kaplan-Meier analysis showed significantly worse survival with elevated NPNR (P < 0.001). In fully adjusted models, NPNR independently predicted all-cause (HR: 2.59, 95% CI: 1.21-5.54) and cardiovascular mortality (HR: 2.87, 95% CI: 1.34-6.15). Compared to the lowest tertile, patients in the highest NPNR tertile had a 2.19-fold higher risk of all-cause mortality (HR: 2.19, 95% CI: 1.55-3.09) and a 2.36-fold higher risk of cardiac death (HR: 2.36, 95% CI: 1.60-3.48).This was validated in the MIMIC-IV cohort (HR:1.91 for 1-year mortality). The association was particularly strong in patients aged ≥65 years. Adding NPNR to a baseline clinical model significantly improved overall discrimination (C-statistic: 0.807-0.811, P = 0.011) and risk reclassification for mortality (continuous NRI = 0.368, IDI = 0.011; both P = 0.013).
CONCLUSION: NPNR is a robust, independent predictor of long-term all-cause and cardiac mortality in AMI patients, validated in the external MIMIC-IV cohort. This simple biomarker effectively aids in risk stratification.
METHODS: This dual-cohort study included 2020 patients from the NOAFCAMI-SH registry in China and 1,433 patients from the MIMIC-IV database in the USA. The primary endpoint was all-cause mortality; the secondary endpoint was cardiovascular mortality. Associations were analyzed using Kaplan-Meier curves, Cox regression, and restricted cubic splines.
RESULTS: During a median 2.5-year follow-up in the discovery cohort, 285 all-cause and 234 cardiovascular deaths occurred. Higher NPNR levels correlated with myocardial injury and lower LVEF. Kaplan-Meier analysis showed significantly worse survival with elevated NPNR (P < 0.001). In fully adjusted models, NPNR independently predicted all-cause (HR: 2.59, 95% CI: 1.21-5.54) and cardiovascular mortality (HR: 2.87, 95% CI: 1.34-6.15). Compared to the lowest tertile, patients in the highest NPNR tertile had a 2.19-fold higher risk of all-cause mortality (HR: 2.19, 95% CI: 1.55-3.09) and a 2.36-fold higher risk of cardiac death (HR: 2.36, 95% CI: 1.60-3.48).This was validated in the MIMIC-IV cohort (HR:1.91 for 1-year mortality). The association was particularly strong in patients aged ≥65 years. Adding NPNR to a baseline clinical model significantly improved overall discrimination (C-statistic: 0.807-0.811, P = 0.011) and risk reclassification for mortality (continuous NRI = 0.368, IDI = 0.011; both P = 0.013).
CONCLUSION: NPNR is a robust, independent predictor of long-term all-cause and cardiac mortality in AMI patients, validated in the external MIMIC-IV cohort. This simple biomarker effectively aids in risk stratification.