The Neutrophil Percentage-to-Albumin Ratio as a Biomarker for All-Cause and Diabetes-Cause Mortality Among Diabetes Patients: Evidence From the NHANES 1988-2018.

Background: Neutrophil percentage-to-albumin ratio (NPAR) was significantly correlated with diabetes-related complications. There are little data about NPAR and mortality risk in individuals with diabetes.

Methods: This study included 3858 diabetes patients from the National Health and Nutrition Examination Survey (NHANES) conducted from 1988 to 2018. Using a restricted cubic spline (RCS), the relationship between the NPAR and mortality risk was shown. Multivariable Cox regression models were used to evaluate the relationship between the NPAR and diabetes-cause and all-cause death. An examination of the time-dependent receiver operating characteristic curve (ROC) was used to assess how well the NPAR predicted survival outcomes.

Results: Among 3858 diabetes individuals, a total of 1198 (31.1%) died over a mean follow-up of 7.86 years; of these, 326 (8.4%) had diabetes-related deaths and 872 (22.6%) had deaths from other causes. The RCS regression analysis showed a positive linear association between the NPAR and all-cause and diabetes-cause mortality. High NPAR group had a significantly higher risk of all-cause and diabetes-cause mortality in univariate and multivariate analysis. Compared with low NPAR group, high NPAR group had a low survival rate of diabetes cases in all-cause death and diabetes-cause mortality with area under the curve of the 3-, 5-, and 10-year ROC curve being 0.725, 0.739, and 0.734 for all-cause mortality and 0.754, 0.752, and 0.745 for diabetes-cause mortality, respectively.

Conclusion: In summary, we examined 3858 diabetes patients from NHANES database (1998-2018) and suggested NPAR as a biomarker for all-cause and diabetes-cause mortality prediction.