The Neutrophil Percentage to Albumin Ratio as a New Predictor of In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

BackgroundNeutrophil and albumin are respective indicators of inflammation and malnutrition. Whether combining those 2 markers can predict acute prognosis in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. This study aimed to investigate the prognostic value of neutrophil percentage to albumin ratio (NPAR) for in-hospital mortality in STEMI patients.Material/MethodsThere were 1024 patients hospitalized with acute STEMI retrospectively enrolled in this study. Demographic, clinical, and admission laboratory data were extracted from medical record. NPAR was calculated as neutrophil percentage numerator divided by albumin in the admission blood samples. In-hospital mortality was designed as the primary outcome in the study, major adverse cardiac events (MACE) and cardiac death were recorded as the secondary clinical outcomes.ResultsThe rates of in-hospital mortality, MACE, and cardiac death in high NPAR group were significantly higher than those in the low NPAR group (P<0.001, P=0.004, P<0.001). The Kaplan-Meier analysis showed worse outcomes in higher NPAR group (P<0.001). NPAR levels and age independently predicted in-hospital mortality. A NPAR value >1.9 was identified as an effective cut point in STEMI for in-hospital mortality (P<0.001, sensitivity 82%, specificity 52%).ConclusionsAdmission NPAR was independently correlated with in-hospital mortality in patients with STEMI.

Association between Neutrophil Percentage-to-Albumin Ratio and All-Cause Mortality in Critically Ill Patients with Coronary Artery Disease

“…As a combination of two classical clinical evaluation parameters, NPAR was proved to be an independent predictor for clinical outcomes of many diseases such as severe sepsis, acute kidney injury, and STEMI [ 9 – 11 ], which had the advantage of simplicity, cheapness, and timeliness. A recent study demonstrated that a higher NPAR was related to higher rates of death and reinfarction during hospitalization in patients with STEMI [ 11 ]. Our study draw a similar conclusion that NPAR was an independent marker for all-cause mortality and had a moderate ability to predict all-cause mortality of critically ill patients with CAD.…”

“…Previous studies also showed that a higher NPAR was associated with clinical outcomes of many diseases such as severe sepsis and acute kidney injury [ 9 , 10 ]. In patients with ST-segment elevation myocardial infarction (STEMI), a higher NPAR was related to higher rates of death and reinfarction during hospitalization [ 11 ]. Based on the above evidence, we deduced that NPAR could influence the mortality of critically ill patients with CAD, and for all we know, there is no study reporting the influence of NPAR on mortality of critically ill patients with CAD.…”

Urinary Alpha1-Microglobulin: A New Predictor for In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction

“…The study’s inclusion criteria were derived from a previous study or guidelines [ 7 , 8 ] and were as follows: (1) The onset of ischemic symptoms lasted >30 min, and the symptoms included various combinations of chest, upper extremity, mandibular, or epigastric discomfort or an ischemic equivalent, such as dyspnea or fatigue [ 7 , 8 ]. (2) Electrocardiographic alterations included new ST elevation in 2 contiguous leads with a cut point ≥1 mm in all leads other than leads V2–V3, where the following cut points applied: ≥2 mm in men ≥40 years; ≥2.5 mm in men <40 years; and ≥1.5 mm in women regardless of age [ 7 , 8 ]. Also, a new left bundle branch block with ischemic repolarization patterns was included [ 7 , 8 ].…”

“…(2) Electrocardiographic alterations included new ST elevation in 2 contiguous leads with a cut point ≥1 mm in all leads other than leads V2–V3, where the following cut points applied: ≥2 mm in men ≥40 years; ≥2.5 mm in men <40 years; and ≥1.5 mm in women regardless of age [ 7 , 8 ]. Also, a new left bundle branch block with ischemic repolarization patterns was included [ 7 , 8 ]. Lastly, (3) cardiac troponin values rose with at least 1 value above the 99 th percentile upper reference limit [ 7 , 8 ].…”

“…Also, a new left bundle branch block with ischemic repolarization patterns was included [ 7 , 8 ]. Lastly, (3) cardiac troponin values rose with at least 1 value above the 99 th percentile upper reference limit [ 7 , 8 ]. To avoid interactions of comorbidities with the level of A1MG or with the in-hospital prognosis of patients, 155 patients were excluded owing to ongoing infection, active cancer, uncontrolled hepatobiliary diseases, end-stage renal disease, hematological diseases, inflammatory or autoimmune disorders, or history of glucocorticoid therapy.…”