Neutrophil Percentage-to-Albumin Ratio (NPAR) independently predicts Group 1 Pulmonary Arterial Hypertension severity and prognosis.
Background
Pulmonary arterial hypertension (PAH) is a severe, progressive, and life-threatening condition characterized by increased pulmonary vascular resistance, ultimately leading to right ventricular failure. Systemic inflammation plays a crucial role in its pathogenesis, contributing to vascular remodeling and disease progression. Current risk stratification methods, while effective, often rely on invasive procedures or expensive tests. There is a critical need for novel, non-invasive, and readily available biomarkers that can accurately reflect disease severity and provide prognostic value, helping to improve patient management and treatment strategies for this complex disease.
Study Design
This retrospective cohort study investigated the utility of the neutrophil percentage-to-albumin ratio (NPAR) in patients with Group 1 PAH. The study enrolled 50 PAH patients (comprising 30 in New York Heart Association [NYHA] class I-II and 20 in class III-IV) alongside 25 healthy controls free from cardiovascular or inflammatory conditions. Researchers collected comprehensive clinical characteristics, standard laboratory parameters, and echocardiographic data. The NPAR was calculated for each participant, and its correlation with established markers of disease severity and other inflammatory indicators was rigorously assessed to determine its diagnostic and prognostic potential.
Results
Levels of hs-CRP (P = 0.02), NT-proBNP (P = 0.03), NPAR (P = 0.01), WBC (P = 0.03), neutrophil (P = 0.02), and albumin (P = 0.02) were all significantly elevated in PAH patients compared to healthy controls. A strong correlation was observed between NPAR and key indicators of disease severity, including systolic pulmonary artery pressure (sPAP), right atrial (RA) area, NT-proBNP, and the 6-min walk distance. Multivariate analysis further established NPAR as an independent predictor of PAH and high-risk PAH [1.029 (1.018-1.039), P < 0.01].
According to the
ROCanalysis, an NPAR threshold exceeding 18.2 proved to be a significant predictor for PAH (P < 0.05) and yielded a sensitivity of 80% and a specificity of 71%, with anAUCof 0.966 (95% CI: 0.95-0.98).
Key Findings
- NPAR was significantly elevated in PAH patients compared to healthy controls (P = 0.01).
- NPAR strongly correlated with established PAH severity markers like sPAP, RA area, and NT-proBNP.
- An NPAR > 18.2 predicted PAH with 80% sensitivity and 71% specificity (AUC 0.966, P < 0.05).
- NPAR emerged as an independent predictor of PAH and high-risk PAH in multivariate analysis (P < 0.01).
Why It Matters
The identification of NPAR as a robust and independent biomarker for PAH severity and prognosis could significantly impact clinical practice. This simple, cost-effective, and readily available blood test could enhance risk stratification and guide treatment decisions for PAH patients. Unlike more invasive or specialized tests, NPAR can be calculated from routine blood work, making it highly accessible for frequent monitoring in various clinical settings. This could lead to earlier identification of high-risk patients, allowing for timely intervention and potentially improving long-term outcomes. For biohackers or individuals monitoring their health, understanding inflammatory markers like NPAR could offer additional insights into cardiovascular risk, though direct application outside clinical guidance for PAH is not yet established.
pulmonary-arterial-hypertension
biomarker
inflammation
cardiovascular
prognosis
retrospective-cohort