Associations of Naples Prognostic Score with Stroke and all-cause mortality in adults : evidence from NHANES (2005-2018)

Abstract

Objective This study seeks to assess the associations of Naples Prognostic Score with stroke and all-cause mortality in adults. Methods We analyzed data from 44,601 participants in the 2005–2018 National Health and Nutrition Examination Survey (NHANES). The Naples Prognostic Score (NPS) was derived from total cholesterol, serum albumin, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Participants were classified into three groups based on their NPS. Stroke incidence was determined through self-reported questionnaires, and mortality data were diligently tracked using the National Death Index. We investigated the relationship between NPS and stroke prevalence using multiple logistic regression analysis. To explore the association between NPS and all-cause mortality in stroke survivors, we applied Kaplan-Meier survival analysis and Cox proportional hazards models. Furthermore, we conducted a detailed subgroup analysis to assess interaction effects on all-cause mortality risk within this population. Results The median age of the participants was 50.00 years [interquartile range: 35.00–64.00], with males comprising 49.36% of the study. The overall stroke prevalence was 3.93%. Participants were categorized into three groups based on their NPS: 6,328 (18.1%) in Group 0 (NPS 0), 24,015 (68.8%) in Group 1 (NPS 1 or 2), and 4,580 (13.1%) in Group 2 (NPS 3 or 4). After adjusting for covariates, individuals in Group 2 exhibited a significantly higher stroke prevalence compared to Group 0, with an odds ratio (OR) of 1.83 [95% confidence interval: 1.49–2.26]. Among the 1,372 patients with a history of stroke, with a median follow-up duration of 5.94 years, we utilized Cox proportional hazards models to assess the relationship between NPS and all-cause mortality risk. The analysis revealed that, after adjusting for covariates, stroke patients in Group 2 faced a significantly elevated risk of all-cause mortality (hazard ratio [HR] = 2.08 [95% confidence interval: 1.40–3.09]) compared to those in Group 0. Subsequent subgroup analyses to explore interaction effects on all-cause mortality risk among stroke patients shown no significant interactions (p for interaction > 0.05). Conclusions This study establishes the associations of Naples Prognostic Score with stroke and all-cause mortality in adults.