Abstract
There has been no study exploring the prognostic values of neutrophil percentage-to-albumin ratio (NPAR). We hypothesised that NPAR is a novel marker of inflammation and is associated with all-cause mortality in patients with severe sepsis or septic shock. Patient data were extracted from the MIMIC-III V1.4 database. Only the data for the first intensive care unit (ICU) admission of each patient were used and baseline data were extracted within 24 h after ICU admission. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with severe sepsis or septic shock. Cox proportional hazards models and subgroup analyses were used to determine the relationship between NPAR and these clinical endpoints. A total of 2166 patients were eligible for this analysis. In multivariate analysis, after adjustments for age, ethnicity and gender, higher NPAR was associated with increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with severe sepsis or septic shock. Furthermore, after adjusting for more confounding factors, higher NPAR remained a significant predictor of all-cause mortality (tertile 3 vs. tertile 1: HR, 95% CI: 1.29, 1.04-1.61; 1.41, 1.16-1.72; 1.44, 1.21-1.71). A similar trend was observed in NPAR levels stratified by quartiles. Higher NPAR was associated with increased risk of all-cause mortality in critically ill patients with severe sepsis or septic shock.
Highlights
Sepsis is a syndrome of physiological, pathological and biochemical abnormalities induced by infection [1]
Studies showed that once sepsis advanced to septic shock, the mortality rate rose from 25% to 52%, despite adoption of therapeutic strategies according to international sepsis guidelines [4, 5]
In model II, after adjusting for age, gender, ethnicity, systolic blood pressure (SBP), diastolic blood pressure (DBP), temperature, SPO2, anion gap, bicarbonate, chloride, haemoglobin, lactate, platelet, activated partial thromboplastin time (APTT), prothrombin time (PT), blood urea nitrogen (BUN), white blood cell (WBC), vasopressor use, atrial fibrillation (AFIB), liver disease, respiratory failure, Sequential organ failure assessment (SOFA) and simplified acute physiology scores II (SAPSII), higher neutrophil percentage-to-albumin ratio (NPAR) was still significantly associated with 30, 90- and 365-day all-cause mortality compared with the low NPAR levels
Summary
Sepsis is a syndrome of physiological, pathological and biochemical abnormalities induced by infection [1]. Previous studies suggested that early higher neutrophil counts correlated with increased sepsis severity [8, 9], and neutrophil percentage was predictive of bloodstream infection [10]. For a variety of physiological mechanisms, albumin is indispensable It has a variety of functions, including serving as a major buffer, extracellular antioxidant, immunomodulator, antidote and transporter in plasma [11, 12]. Increased capillary leakage of albumin is one of the features of SIRS [13]. This means that lower albumin levels correlate with severe systemic inflammation and organ failure [14]. Several studies demonstrated that low albumin levels correlated with adverse clinical outcomes [11, 15]
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