Neutrophil-to-albumin Ratio Research Articles

Potential biomarkers in Behçet’s disease: monocyte, neutrophil, platelet, and C-reactive protein to albumin ratios

IntroductionThe objective of this cross-sectional study was to evaluate the monocyte to albumin ratio (MAR), neutrophil to albumin ratio (NAR), platelet to albumin ratio (PAR), and C-reactive protein to albumin ratio (CAR) as potential biomarkers for disease activity in patients with Behçet’s disease (BD).Material and methodsBoth BD cases and healthy controls were enrolled in this study. Demographic characteristics, disease duration, and current medications were recorded for all participants. The BD Current Activity Form (BDCAF) was utilized to assess the activity of BD. Additionally, ery­throcyte sedi­mentation rate, CRP, and serum albumin levels were measured. The MAR, NAR, PAR, and CAR were compared between the two groups. Correlation analysis and receiver operating characteristic curves (ROC) were employed to establish cut-off points for these biomarkers.ResultsIn the study, both BD cases and 45 controls were included, totaling 90 participants. Significant differences were observed in the mean ±SD values of ESR, MAR, PAR, CAR, and albumin between the BD cases and controls (<i>p</i> = 0.008, <i>p</i> = 0.009, <i>p</i> = 0.029, <i>p</i> = 0.034, <i>p</i> = 0.006, respectively). However, despite these differences, no significant correlation was detected between BDCAF and the parameters under investigation. The cutoff point was determined as 150.59 (sensitivity 46.67%, specificity 82.22%, <i>p</i> = 0.008, AUC = 0.655) for MAR; as 62,013.73 (sensitivity 60.00%, specificity 66.67%, <i>p</i> = 0.03, AUC = 0.629) for PAR; and as 1.16 (sensitivity 35.56%, specificity of 95.567%, <i>p</i> = 0.03, AUC = 0.629) for CAR. The results were not able to define any cut-off points for active-inactive BD.ConclusionsSignificantly higher levels of MAR, PAR, and CAR were observed in patients with BD than controls. Monocyte to albumin ratio, PAR, and CAR were notably elevated in patients with active BD. This finding suggests that these parameters possess discriminative ability and could potentially serve as biomarkers to aid in the clinical evaluation of BD.

Changes in the ratio of neutrophils to albumin depending on the severity of abdominal sepsis in patients with benign and malignant non-traumatic perforation of the left colon

Background. According to the Third International Consensus (Sepsis-3), sepsis is defined as a life-threatening organ dysfunction caused by an uncontrolled response of the affected organism to a new infection, and septic shock as a sepsis-related condition characterized by the development of circulatory failure accompanied by arterial hypotension, with lactatemia and requiring maintenance of blood pressure with vasopressors. Despite progress in diagnosing and treating sepsis in patients with intra-abdominal infections, it continues to be the leading cause of mortality among patients in emergency departments worldwide. Purpose – the objective of this study was to ascertain the capacity of the neutrophilto-albumin ratio (NAR) before surgery to predict the severity of abdominal sepsis and 30-day mortality in patients with benign and malignant non-traumatic perforation left side of the colon. Methods. This was a retrospective, cross-sectional study that analyzed 117 patients of different age groups with sepsis caused by colon perforation who were hospitalized and operated on from January 2014 to March 2024. To evaluate the diagnostic value of INA in predicting sepsis severity and 30-day mortality, we analyzed the biomarker’s ROC curves, including the determination of optimal cut-off thresholds and associated specificity and sensitivity. The association of INA, sepsis severity, and perforation type with 30-day mortality was investigated using survival analysis, including the comparison of Kaplan–Meier curves and the development and analysis of Cox proportional hazards regression models. Comparisons between groups of study patients concerning quantitative characteristics were conducted, with the presence of septic shock and treatment outcome serving as the independent variables. This was done using nonparametric criteria for independent measurements, specifically the Kruskal–Wallis and Mann–Whitney tests. The statistical significance of the relationships between the qualitative indicators of the study was assessed based on the χ2 criterion and the odds ratio. Results. The results demonstrated that the INR has a high prognostic value in determining the severity of sepsis. This was evidenced by a high value of the area under the ROC curve (AUC = 0.948, p = 2, 309×10–41 < 0.05, 95% CI = 0.882–1.013). It has been demonstrated that the development of septic shock can be predicted by a preoperative INA value not exceeding 22.1, with the highest possible specificity (93.4%) and sensitivity (92.3%). The INA was also found to be an effective predictor of 30-day mortality in our data. The optimal INA threshold for mortality prediction was 23.8, with a specificity of 77.1 and sensitivity of 78.7% (AUC = 0.862, p = 6,072 ×10–28 < 0.05, 95% CI = 0.786-0.919). Furthermore, no statistically significant association was observed between the type of perforation and patient outcomes (χ2 = 0.00493, p = 0.944, p > 0.05). However, our study did confirm higher 30-day mortality in patients with colonic perforation in the presence of septic shock compared to patients with sepsis. Conclusions. The neutrophil-to-albumin ratio has been identified as an accurate and reliable biomarker for predicting the severity of abdominal sepsis. The biomarker demonstrated a specificity of 93.4%, a sensitivity of 92.3%, and a cut-off value of 22.1 for stratifying patients with septic shock. Furthermore, this biomarker was identified as an important predictor of 30-day mortality in both types of perforation, with an area under the ROC curve (AUC) of 0.862. Nevertheless, the value of this indicator for predicting mortality was somewhat lower than for determining septic shock. Furthermore, the results of the Cox regression analysis indicated that the impact of IA on survival was more pronounced in patients with malignant colon perforation. In patients with benign colon perforation, the model demonstrated a satisfactory fit to the input data. The presence or absence of septic shock did not influence the survival of patients in this category. The findings of the study indicated a significant correlation between INA and sepsis severity, suggesting that this indicator may serve as a straightforward prognostic tool for determining the severity of sepsis before surgery. Ultimately, the stratification of patients according to the severity of sepsis before surgery may lead to improved clinical outcomes for these patients.

The relationship between the new inflammatory markers and disease severity in patients with acute coronary syndrome

Background Inflammation plays a crucial role in the progression of acute coronary syndrome. Aims The aim of this study was to investigate the relationship between the SYNTAX score and new inflammatory markers including albumin-globulin ratio (AGR), C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-albumin ratio (NAR), and neutrophil percentage-to-albumin ratio (NPAR) in STEMI and NSTEMI patients. Methods The study involved 53 STEMI and 64 NSTEMI patients, and each patient group was evaluated separately. Multivariate linear regression analysis was utilised to identify independent risk factors associated with SYNTAX scores. Results Out of the 64 NSTEMI patients, 42 had low SYNTAX score (65.6%), and 22 had high SYNTAX score (34.4%). Patients with high SYNTAX scores had significantly higher levels of age, glucose, fibrinogen, monocyte, and FAR, and lower levels of albumin and total protein. We found that FAR and monocyte levels were independent predictors of the high SYNTAX score. The study also determined that the cut-off value for FAR as 9.99, with a sensitivity of 81% and a specificity of 73% for predicting high SYNTAX score in NSTEMI patients. Out of the 53 STEMI patients, 42 had low SYNTAX score (79.2%), and 11 had high SYNTAX score (20.8%). Patients with high SYNTAX scores exhibited significantly higher total cholesterol, LDL, and glucose levels, and lower albumin and total protein levels. Conclusions The FAR level is significantly linked with the high SYNTAX score and can be a useful marker for predicting the severity of disease in NSTEMI patients.

Exploring mean platelet volume and neutrophil-to-albumin ratio as surrogate markers for monitoring tuberculosis treatment: a prospective longitudinal study

BackgroundTuberculosis (TB) remains a global health challenge, with India bearing a significant burden. Despite advancements in TB diagnosis and treatment, monitoring TB treatment is challenging, particularly in resource-limited settings. This study aimed to explore the mean platelet volume (MPV) as a potential surrogate marker for monitoring TB treatment and assessing if the neutrophil-to-albumin ratio (NAR) enhances treatment monitoring.MethodsPatients diagnosed with TB following NTEP guidelines were recruited. Participants underwent routine blood tests during the six-month Anti-Tubercular therapy course at the start, end of the intensive phase, and end of the continuous phase. Statistical analyses included Spearman correlation, Friedman test, linear mixed effects (LME) models, and multiple linear regression.Results150 individuals were included for analysis. Deviations from normality were noted. Significant associations were found between CRP and sputum grade. MPV mediated between CRP and sputum grade. Significant differences were observed across the three-time points. LME models showed changes in MPV and CRP levels over time. Including NAR enhanced predictive capability.ConclusionsMPV may serve as a promising surrogate marker for monitoring ATT. Personalized approaches are crucial in TB treatment monitoring. LME models revealed MPV and CRP level trends. Future research should explore MPV’s treatment response mechanisms and cost-effectiveness.

Neutrophil-to-albumin Ratio as a Prognostic Factor in Patients with Acute Ischemic Stroke.

Neutrophil-To-Albumin Ratio (NAR) is a novel inflammatory biomarker. However, the potential prognostic value of NAR in acute ischemic stroke (AIS) remains unclear. This study aimed to evaluate whether NAR levels correlated with the 3-month modified Rankin scale (mRS) in patients with AIS. AIS patients were included in this retrospective study. NAR was calculated as the ratio of absolute neutrophil count to serum albumin level. Logistic regression analyses were used to investigate the effect of NAR on 3-month mRS of AIS. The predictive values of NAR, albumin level, and neutrophil count were compared utilizing receiver operating characteristic (ROC) curves. Moreover, subgroup analyses and interaction tests were conducted to evaluate the consistency of NAR's effect on AIS prognosis. Of the 780 patients included, 403 (51.67%) had a poor clinical outcome (mRS 3-6) at 3 months. NAR was independently correlated to 3-month poor functional outcome after adjusting for confounders (Odds ratios (OR), 9.34; 95% confidence intervals (CI), 1.09 to 80.13; p =0.0417). Subgroup analysis showed a relative effect consistent with the overall population results, and no statistical interactions were found in the subgroups (all p for interaction > 0.05). The ROC curve showed that the prognosis-related cutoff value for NAR was 0.123, with corresponding specificity and sensitivity of 53.55% and 63.94%, respectively. When comparing the predictive power, NAR (0.590; 95%CI 0.549-0.630) exhibited the highest area under the curve (AUC) of ROC compared to neutrophils (0.584; 95%CI 0.543-0.624) and albumin (0.540; 95%CI 0.500-0.581). There is a positive relationship between NAR levels and 3-month poor functional outcomes in AIS patients, supporting the potential of NAR as a readily available and economic serum biomarker for the early identification of AIS prognosis. Further studies are required to validate the prognostic value and clinical utility of the NAR.

Development and validation of a novel nomogram model predicting the unfavorable outcome based on NAR and collaterals status for patients with AIS

IntroductionStroke is a leading cause of disability and mortality globally. This study aimed to develop a prognostic nomogram based on neutrophil-to-albumin ratio (NAR) and collateral status in acute ischemic stroke (AIS) patients with anterior large vessel occlusion (LVO). Material & method590 AIS patients with LVO assessed for regional leptomeningeal collateral (rLMC) were retrospectively enrolled, and randomly divided into a training set (n = 414) and a testing set (n = 176). Unfavorable functional outcome was defined as a modified Rankin scale (mRS) score of 3 to 6 at 3 months. We assessed the accuracy and clinical utility of the nomogram using calibration plots, area under the curve (AUC), decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI). ResultsBoth NAR and rLMC were independently associated with unfavorable outcome at 3 months (OR=8.96, p=0.0341; OR=0.89, p=0.0002, respectively). The developed nomogram (akaike information criterion (AIC)=398.77), which included NAR, rLMC and other factors, showed good performance (the AUC for the development and validation cohorts was 0.848 and 0.840 respectively) and improved the predictive value compared to a model without NAR and rLMC, according to an overall NRI of 3.27% (p=0.2401), overall IDI of 3.27% (p=0.2414), and a higher AUC (0.848 vs 0.831). ConclusionsNAR can serve as an independent predictor in AIS patients with anterior LVO, and the nomogram incorporating NAR and rLMC is reliable in predicting unfavorable outcome. Further studies with larger sample sizes are needed to validate and extend these findings.

Inflammatory indexes predict mortality in non-malignant patients in palliative care.

The literature on the use of inflammatory indexes for palliative care patients without malignancy is scarce. To determine which inflammatory indexes are associated with the mortality risks of non-malignant patients hospitalised and receiving palliative care. Discharged or deceased patients in a palliative care unit of a secondary care hospital were included. The laboratory values were obtained during the first 48 hours of hospitalisation. As a result of univariate Cox regression analysis, 14-day mortality rate was affected by lymphocyte ratio, neutrophil-to-albumin ratio (NAR), C-reactive protein/albumin ratio (CAR), multi-inflammatory indexes (MII-1) and MII-2 (p<0.001, p=0.001, p=0.002, p=0.009 and p=0.003, respectively); NLR, CLR, NAR, CAR, MII-1 and MII-2 (respectively p=0.005, p<0.001, p<0.001, p<0.001, p=0.001 and p<0.001) affected 28-day mortality rate. Indexes that statistically significantly increased both 14-day and 28-day mortality rates independently of other variables were CLR, NAR, CAR, MII-1 and MII-2. High values in inflammatory indexes, including C-reactive protein and albumin increase the risk of 14-day and 28-day mortality rates in palliative care non-malignant patients.

The Neutrophil-to-Albumin Ratio (NAR): A Novel Index in Relation to Clinical Symptoms, Quality of Life, and Psychological Status in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D).

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain and alterations in bowel habits. Despite the importance of biomarkers in disease management, the quest for precise and non-invasive biomarkers for IBS continues. This study focuses on investigating the clinical significance of the neutrophil-to-albumin ratio (NAR) as a potential biomarker in IBS. A cohort of 86 patients diagnosed with diarrhea-predominant IBS (IBS-D) and 106 healthy individuals were assessed for clinical symptoms, quality of life (QOL), psychological status, as well as serum and mucosal cytokine production. Our findings revealed that NAR levels were notably elevated in patients with IBS-D compared to healthy controls. Positive correlations were observed between NAR levels and IBS clinical symptoms, while negative correlations were noted with QOL. Additionally, NAR showed positive associations with anxiety and depression scores, along with significant relationships with cytokine production (serum IL-6, TNF-α, IL-1β, IL-17A, GM-CSF, IFN-γ, MCP-1; mucosal IL-6, TNF-α, IL-1β, IL-17A) in IBS-D. Interestingly, patients with lower baseline NAR levels demonstrated potentially better clinical outcomes. The study underscores the potential utility of NAR as a novel biomarker in IBS, emphasizing its role in enhancing disease monitoring, understanding disease pathophysiology, and tailoring treatment strategies for patients with IBS-D.

Relationship between neutrophil to lymphocytes ratio, red cell distribution width, procalcitonin, neutrophil to albumin ratio, and bun to albumin ratio with mortality of severe cap patients with septic shock

Background: Septic shock is one of severe community-acquired pneumonia (CAP) complication with high mortality. Various laboratory parameters had been associated with poor outcome including neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), procalcitonin, neutrophil to albumin ratio (NAR), and bun to albumin ratio (BAR). This study aimed to know the relationship between inflammatory markers with mortality of severe CAP patients with septic shock. Methods: This study is an observational analytic study using a cohort retrospective design conducted in Prof. I.G.N.G. Ngoerah General Hospital over a 3 years’ period (January 2020 to July 2023). The relative risk (RR) values showed relative risk of each parameter to mortality. Results: Of total 73 subjects, mortality was found in 68.5%. Male predominance was found (65.8%). Comorbid disease was reported in 69 subjects (94.5%), most found was cardiovascular disease (63%). Majority of the subjects did not have history of prior antibiotics use (86.3%). In multivariate analysis, it was found that NLR with cutoff ≥16.5 (p value 0.044; 95% CI 1.039-14.011; RR 3.816), procalcitonin ≥1.82 (p value 0.029; 95% CI 1.148-13.560; RR 3.945), and BAR ≥8.13 (p value 0.003; 95% CI 1.961-21.912; RR 7.399) are associated with mortality. There was no relationship between RDW ≥14.65 (p value 0.159; 95% CI 0.658-12.877) and NAR ≥4.5 (p value 0.436; 95% CI 0.429-7.106) with mortality in this study. Conclusions: Mortality of severe CAP patients with septic shock in this study is high. Higher NLR, procalcitonin, and BAR values have a significant relationship with mortality of severe CAP patients with septic shock.

Development and performance assessment of novel machine learning models for predicting postoperative pneumonia in aneurysmal subarachnoid hemorrhage patients: external validation in MIMIC-IV.

Postoperative pneumonia (POP) is one of the primary complications after aneurysmal subarachnoid hemorrhage (aSAH) and is associated with postoperative mortality, extended hospital stay, and increased medical fee. Early identification of pneumonia and more aggressive treatment can improve patient outcomes. We aimed to develop a model to predict POP in aSAH patients using machine learning (ML) methods. This internal cohort study included 706 patients with aSAH undergoing intracranial aneurysm embolization or aneurysm clipping. The cohort was randomly split into a train set (80%) and a testing set (20%). Perioperative information was collected from participants to establish 6 machine learning models for predicting POP after surgical treatment. The area under the receiver operating characteristic curve (AUC), precision-recall curve were used to assess the accuracy, discriminative power, and clinical validity of the predictions. The final model was validated using an external validation set of 97 samples from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. In this study, 15.01% of patients in the training set and 12.06% in the testing set with POP after underwent surgery. Multivariate logistic regression analysis showed that mechanical ventilation time (MVT), Glasgow Coma Scale (GCS), Smoking history, albumin level, neutrophil-to-albumin Ratio (NAR), c-reactive protein (CRP)-to-albumin ratio (CAR) were independent predictors of POP. The logistic regression (LR) model presented significantly better predictive performance (AUC: 0.91) than other models and also performed well in the external validation set (AUC: 0.89). A machine learning model for predicting POP in aSAH patients was successfully developed using a machine learning algorithm based on six perioperative variables, which could guide high-risk POP patients to take appropriate preventive measures.

Neutrophil to albumin ratio: a biomarker in non-alcoholic fatty liver disease and with liver fibrosis.

Given the high prevalence of non-alcoholic fatty liver disease (NAFLD) and its potential to progress to liver fibrosis, it is crucial to identify the presence of NAFLD in patients to guide their subsequent management. However, the current availability of non-invasive biomarkers for NAFLD remains limited. Therefore, further investigation is needed to identify and develop non-invasive biomarkers for NAFLD. A retrospective analysis was conducted on 11,883 patients admitted to the Healthcare Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2016 to December 2019 and divided into NAFLD and non-NAFLD groups. Anthropometric and laboratory examination data were collected. The correlations between variables and NAFLD were evaluated using the student's t-test or Mann-Whitney U test and binary logistic regression analysis. The predictive ability of these variables for NAFLD was assessed using the areas under the curves (AUCs) of receiver operating characteristics. Among the included patients, 3,872 (32.58%) were diagnosed with NAFLD, with 386 (9.97%) individuals having liver fibrosis. Patients with NAFLD exhibited a higher proportion of males, elevated body mass index (BMI), and increased likelihood of hypertension, diabetes mellitus, and atherosclerosis. Logistic regression analysis identified the neutrophil to albumin ratio (NAR) as the most promising novel inflammation biomarkers, with the highest AUC value of 0.701, a cut-off value of 0.797, sensitivity of 69.40%, and specificity of 66.00% in identifying the risk of NAFLD. Moreover, NAR demonstrated superior predictive value in identifying NAFLD patients at risk of liver fibrosis, with an AUC value of 0.795, sensitivity of 71.30%, and specificity of 73.60% when NAR reached 1.285. These findings highlight that the novel inflammatory biomarker, NAR, is a convenient and easily accessible non-invasive predictor for NAFLD and NAFLD with liver fibrosis.

Enteral nutrition in the management of acute pancreatitis: Modulates gut microbiome and alleviates inflammation

BackgroundEnteral nutrition (EN) represents a fundamental and efficacious therapeutic approach in acute pancreatitis (AP). Our objective is to investigate the modulation of gut microbiota through enteral nutrition. MethodsThis prospective observational study enrolled 35 AP patients and implemented timely enteral nutrition intervention. Inflammatory markers, including C-reactive protein (CRP), were assessed before and after EN, while the dynamic alterations in gut microbiota were analyzed using 16S rDNA sequencing technology. ResultsFollowing EN, CRP significantly decreased, effectively mitigating the inflammatory response. Due to inter-individual variations in post-enteral nutrition inflammatory status, patients were further stratified into H group (CRP≥50 mg/L) and L group (CRP<50 mg/L) for subsequent analysis. Comparative evaluation of clinical characteristics between the two groups revealed that the H group exhibited a significantly higher risk of adverse prognosis including respiratory dysfunction and infectious complications. Dynamic monitoring of gut microbiota demonstrated a substantial increase in microbial diversity after EN accompanied by a decrease in opportunistic pathogens such as Enterococcus, Escherella-Shigella, and Klebsiella, along with an augmentation of beneficial bacteria including Bacteroides and Fusobacterium. The composition of gut microbiota varied according to the levels of inflammation among AP patients: Shigella predominated within Group H, while Actinomyces and Enterococcus constituted the dominant bacterial population within Group L. Furthermore, Spearman correlation analysis revealed significant associations between specific microbial communities within the gut and inflammatory markers such as neutrophil to albumin ratio (NAR) and lymphocyte to C-reactive protein ratio (LCR). ConclusionsEN can modify gut microbiota and alleviate inflammation, thereby affecting the severity and prognosis of AP patients.

C-reactive protein-to-albumin ratio and neutrophil-to-albumin ratio for predicting response and prognosis to infliximab in ulcerative colitis.

The C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-albumin ratio (NAR) serve as established markers for inflammatory diseases. However, limited studies have investigated their potential in predicting response and prognosis following infliximab (IFX) treatment. The objective of this paper was to evaluate feasibility of CAR and NAR as biomarkers to assess response to IFX induction therapy. Additionally, we attempted to determine the capacity to predict clinical remission in ulcerative colitis (UC) after 54 weeks of IFX treatment. We enrolled a total of 157 UC patients diagnosed via endoscopic mucosal biopsy at our hospital between October 2018 and June 2023. Additionally, 199 patients presenting with gastrointestinal symptoms, who underwent physical examinations, constituted the control group. Comprehensive clinical data, laboratory indicators, and endoscopic findings were systematically collected. CAR and NAR values were computed before treatment, post-induction, and subsequently at 8-week intervals. Comparisons between two groups were analyzed using the Wilcoxon rank-sum test or the independent samples t-test, and comparisons between multiple groups were analyzed using the one-way ANOVA (analysis of variance) or the Kruskal-Wallis rank sum test. We found CAR and NAR emerged as sensitive biomarkers for assessing disease activity. Notably, our findings indicated their dual predictive capability: foreseeing response post-IFX induction therapy and prognosticating the likelihood of UC patients achieving clinical remission following 54 weeks on IFX therapy.

Evaluation and validation of neutrophil to albumin ratio as a promising prognostic marker for all-cause mortality in patients with cancer: a multicenter cohort study

ObjectivesThe practicality and effectiveness of using the prognostic value of the neutrophil-to-albumin ratio (NAR) in evaluating patients with cancer remain unclear, and research is needed to fully understand its potential application in the cancer population. MethodsThe Kaplan–Meier method was used for survival analysis, and the log-rank test was employed for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the prognostic biomarkers, and Logistic regression analysis was conducted to investigate the relationship between NAR and 90-day outcomes and cachexia. ResultsThe study included 14 682 patients with cancer, divided into discovery (6592 patients), internal validation (2820 patients), and external validation groups (5270 patients). Patients with high NAR had higher all-cause mortality than those with low NAR in the discovery (50.15% versus 69.29%, P < 0.001), internal validation (54.18% versus 70.91%, P < 0.001), and external validation cohorts (40.60% versus 66.68%, P < 0.001). In the discovery cohort, high NAR was observed to be independently associated with all-cause mortality in patients (HR 1.16, 95% CI 1.12–1.19; P < 0.001). Moreover, we validated the promising prognostic value of NAR as a predictor of survival in patients with cancer through internal validation (HR 1.21, 95% CI 1.16–1.27, P < 0.001) and external validation cohorts (HR 1.27, 95% CI 1.21–1.34, P < 0.001). Additionally, in the subgroup analysis by tumor type, high NAR was identified as a risk factor for most cancers, except for breast cancer. ConclusionsThis study showed that NAR is a feasible and promising biomarker for predicting prognosis and cancer cachexia in cancer patients.

Predictive Value of Pretreatment Neutrophil to Albumin Ratio in Response to Neoadjuvant Chemotherapy of Breast Cancer.

The immune system appears to play a crucial role in how breast cancer responds to chemotherapy. In this study, we investigated a peripheral marker of immune and inflammation named the neutrophil to albumin ratio (NAR) to explore its potential relationship with pathological complete response (pCR) in locally advanced breast cancer patients who underwent neoadjuvant chemotherapy (NAC). We conducted a retrospective analysis of 212 consecutive breast cancer patients who received NAC. The NAR was calculated by examining the complete blood cell count and albumin level in peripheral blood before starting NAC. Through ROC curve analysis, we determined the optimal cutoff value for NAR as 0.0877. We used Pearson's chi-square test or Fisher's exact test to evaluate the relationship between NAR and pCR, as well as other clinical and pathological characteristics. Logistic regression models were employed for univariate and multivariate analyses. The results of both univariate and multivariate logistic regression analyses showed that NAR was associated with tumor pathological regression. The NAR high group had a higher pCR rate compared to the NAR low group (OR 3.127 [95% CI 1.545-6.328]; p = 0.002). According to this study, it was observed that patients with breast cancer who had high levels of NAR were more likely to achieve pCR when undergoing NAC.

Machine Learning-Based Prediction of Pulmonary Embolism Prognosis Using Nutritional and Inflammatory Indices

Purpose This study aimed to create and assess machine learning (ML) models that utilize nutritional and inflammatory indices, focusing on the advanced lung cancer inflammation index (ALI) and neutrophil-to-albumin ratio (NAR), to improve the prediction accuracy of PE prognosis. Patients and methods We conducted a retrospective analysis of 312 patients, comprising 254 survivors and 58 non-survivors. The Boruta algorithm was used to identify significant variables, and four ML models (XGBoost, Random Forest, Logistic Regression, and SVM) were employed to analyze the clinical data and assess the performance of the models. Results The XGBoost model, with optimal hyperparameters, achieved the best performance, with an accuracy of 0.882, an F1-score of 0.889, a precision of 0.917, a sensitivity of 0.863, a specificity of 0.905, and an AUC of 0.873. Analysis of feature importance indicated that the most critical predictors across models were respiratory failure, log-transformed ALI, albumin level, age, diastolic blood pressure, and NAR. Conclusion The ML-based prediction models effectively predicted the prognosis of PE, with the XGBoost model exhibiting good performance. Respiratory failure, ALI, albumin level, age, diastolic blood pressure, and NAR were correlated with PE prognosis.

Neutrophil-to-albumin ratio: a promising tool for CAD assessment in non-ST elevation AMI.

In the context of coronary artery disease (CAD) pathogenesis, inflammation has emerged as a critical player. This study investigates the potential of the Neutrophil-to-Albumin Ratio (NAR) as a novel biomarker for assessing CAD severity and extension in patients suffering from acute myocardial infarction (AMI) without ST-segment elevation. We conducted a comprehensive analysis of consecutive patient records (n = 211) from a single center, focusing on individuals diagnosed with non-ST elevation AMI. To gauge CAD severity, we employed Syntax Scores (SS) and examined their correlation with NAR, C-reactive protein-albumin ratio (CRPALB), and the systemic immune inflammation index (SII). Statistical analyses were conducted to establish associations and predictive capabilities. Our analysis revealed a significant correlation between NAR and Syntax Scores (r: .416, p<0.01). Notably, patients with intermediate-high SS exhibited significantly elevated NAR values compared to those in the low SS group [20.86+5.38 vs. 16.41+6.30 (p<0.001)]. Furthermore, NAR outperformed CRPALB, SII, and Neutrophil Percent-to-Albumin Ratio (NPAR) in discriminating CAD severity, as demonstrated by the Receiver Operating Characteristic (ROC) curve analysis (NAR AUC: 0.736; CRPALB AUC: 0.673; SII AUC: 0.660; NPAR AUC: 0.717). This study underscores the potential of NAR as a robust predictor of CAD severity and extension in non-ST elevation AMI patients. While previous markers, such as CRPALB and SII, are advantageous, NAR's superior predictive capabilities are a valuable addition to the clinician's toolkit, offering enhanced risk assessment for this specific patient subgroup.

Inflammatory and nutritional markers predict the risk of post-operative delirium in elderly patients following total hip arthroplasty.

This study intended to explore whether albumin-associated inflammatory and nutritional markers could predict post-operative delirium (POD) in older patients after total hip arthroplasty (THA). In addition, we established a nomogram model for POD prediction. Totally, 254 elderly cases who received THA were included. Clinical and laboratory data of these patients were retrospectively collected. Albumin-associated inflammatory and nutritional markers included neutrophil-to-albumin ratio (NAR), CRP-to-albumin ratio (CAR), prognostic nutritional index (PNI), and systemic inflammation score (SIS). The LASSO, univariate and multivariate logistic regression analyses were utilized to screen risk factors. A nomogram model was developed according to the results of multivariate regression analyses. Among 254 patients, 49 cases had POD with an incidence of 19.3%. LASSO regression and multivariate logistic analyses suggested that preoperative NAR, preoperative PNI, preoperative SIS, and age >75 years were risk factors for POD. A nomogram model was developed according to the results of multivariate logistic analyses. The calibration curve suggested that the predicted probability of this nomogram model was in good line with the actual probability. The DCA showed that this nomogram model had net benefits for the prediction of POD for elderly patients following THA. Albumin-associated inflammatory and nutritional markers including NAR, PNI, and SIS could predict POD in elderly patients following THA.

Association between neutrophil-to-albumin ratio and long-term mortality of aneurysmal subarachnoid hemorrhage

ObjectiveThe prognosis of aneurysmal subarachnoid hemorrhage (aSAH) survivors is concerning. The goal of this study was to investigate and demonstrate the relationship between the neutrophil-to-albumin ratio (NAR) and long-term mortality of aSAH survivors.MethodsA retrospective observational cohort study was conducted at Sichuan University West China Hospital between January 2009 and June 2019. The investigation of relationship between NAR and long-term mortality was conducted using univariable and multivariable Cox regression models. To demonstrate the predictive performance of different biomarkers over time, time-dependent receiver operating characteristic curve (ROC) analysis and decision curve analysis (DCA) were created.ResultsIn total, 3173 aSAH patients were included in this study. There was a strong and continuous relationship between NAR levels and long-term mortality (HR 3.23 95% CI 2.75–3.79, p < 0.001). After adjustment, the result was still significant (adjusted HR 1.78 95% CI 1.49–2.12). Compared with patients with the lowest quartile (< 0.15) of NAR levels, the risk of long-term mortality in the other groups was higher (0.15–0.20: adjusted HR 1.30 95% CI 0.97–1.73; 0.20–0.28: adjusted HR 1.37 95% CI 1.03–1.82; >0.28: adjusted HR 1.74 95% CI 1.30–2.32). Results in survivors were found to be still robust. Moreover, out of all the inflammatory markers studied, NAR demonstrated the highest correlation with long-term mortality.ConclusionsA high level of NAR was associated with increased long-term mortality among patients with aSAH. NAR was a promising inflammatory marker for long-term mortality of aSAH.

Prognostic utility of neutrophil-to-albumin ratio in surgically treated oral squamous cell carcinoma.

We aimed to evaluate the prognostic significance of preoperative neutrophil-to-albumin ratio (NAR) in oral squamous cell carcinoma (OSCC). A total of 622 patients with surgically treated OSCC were enrolled. NAR was defined as the absolute neutrophil count divided by the serum albumin level in peripheral blood before the radical surgery. Cox proportional hazards model were used to discover survival outcome-associated factors. The optimal cut-off of NAR to predict overall survival (OS) was determined to be 0.1. In Cox model, high NAR was identified as an independent negative prognosticator of OS, cancer-specific survival, and recurrence-free survival (adjusted hazard ratio: 1.503, 1.958, and 1.727, respectively; all p < 0.05). The NAR-based nomogram accurately predicted OS (concordance index: 0.750). Our study suggests that preoperative NAR is a convenient and effective prognostic marker for OSCC and NAR-based nomogram can be a promising prognostic tool in clinical setting.