Comprehensive Insights into the Neutrophil Percentage to Albumin Ratio (NPAR): An Emerging Integrated Biomarker for Inflammation and Prognosis

Neutrophil Percentage to Albumin Ratio: Emerging Integrated Biomarker for Inflammation

Authors

  • Maeesa Wadood Department of Pathology, Baqai Medical University, Karachi, Pakistan
  • Abeer Memon Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
  • Wardah Salman Department of Medicine, Punjab Rangers Teaching Hospital, Lahore, Pakistan
  • Anum Iftikhar Department of Pathology, Bahawalpur Medical and Dental College, Bahawalpur, Pakistan
  • Fatima Raza Department of Pathology, Postgraduate Medical Institute/ Ameer-Ud-Din Medical College, Lahore, Pakistan
  • Naveed Ahsan Department of Biochemistry, Bhitai Dental and Medical College, Mirpurkhas, Pakistan
  • Muhammad Hussain Department of Molecular Pathology, University of Health Sciences, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i10.2401

Keywords:

Neutrophil Percentage to Albumin Ratio, Inflammation, Prognosis, Biomarkers

Abstract

Neutrophil Percentage to Albumin Ratio is a new biomarker that measures inflammation severity and prognosis in many inflammatory diseases. Objectives: To systematically assess the role of neutrophil percentage to albumin ratio in predicting inflammation and patient prognosis compared to conventional biomarkers C-reactive protein and procalcitonin, in inflammatory diseases. Methods: PRISMA guidelines were followed by electronic databases such as PubMed, Science Direct, and Google Scholar using keywords including 'Neutrophil Percentage to Albumin Ratio', 'inflammation', 'biomarkers' and 'prognoses’ from 2014 to 2024. Some studies examined the interaction between neutrophil percentage to albumin ratio with systemic inflammation, immune dysfunction and organ injury. Two aspects were analysed comprehensively regarding the comparison of neutrophil percentage to albumin ratio with conventional inflammation biomarkers with consideration of age, baseline characteristics, and comorbidity along with the neutrophil percentage to albumin ratio evaluation in the spectrum of various disorders. A total of 99 studies were taken into consideration for initial screening, finally, 18 studies were taken for in-depth analysis. Results: The review showed a significant correlation between higher values of neutrophil percentage to albumin ratio and inflammation, organ, and clinical deterioration. neutrophil percentage to albumin ratio demonstrates higher accuracy in evaluating the severity of inflammation and patient prognosis compared to classical markers, particularly in critical conditions. Conclusions: It was concluded that neutrophil percentage to albumin ratio becomes ideal as a stable multiple biomarker to measure inflammation and the overall patient prognosis. Utilization of markers in clinical practice could lead to improved recognition of severe inflammation states

References

Ji W, Li H, Qi Y, Zhou W, Chang Y, Xu D et al. Association Between Neutrophil-Percentage-To-Albumin Ratio (NPAR) and Metabolic Syndrome Risk: Insights from A Large US Population-Based Study. Scientific Reports. 2024 Nov; 14(1): 26646. doi: 10.1038/s41598-024-77802-y.

La Via L, Sangiorgio G, Stefani S, Marino A, Nunnari G, Cocuzza S et al. The Global Burden of Sepsis and Septic Shock. Epidemiologia. 2024 Jul; 5(3): 456-78. doi: 10.3390/epidemiologia5030032.

Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al. Global, Regional, and National Sepsis Incidence and Mortality, 1990–2017: Analysis for the Global Burden of Disease Study. The Lancet. 2020 Jan; 395(10219): 200-11. doi: 10.1016/S0140-6736(19)32989-7.

Yu Y, Liu Y, Ling X, Huang R, Wang S, Min J et al. The Neutrophil Percentage‐To‐Albumin Ratio as A New Predictor of All‐Cause Mortality in Patients with Cardiogenic Shock. BioMed Research International. 2020; 2020(1): 7458451. doi: 10.1155/2020/7458451.

Yao J, Xu X, Gong K, Tu H, Xu Z, Ye S et al. Prognostic Value of Neutrophil Count to Albumin Ratio in Patients with Decompensated Cirrhosis. Scientific Reports. 2023 Nov; 13(1): 20759. doi: 10.1038/s41598-023-44842-9.

Zhang X, Liu Y, Zhang S, Wang C, Zou C, Li A. Neutrophil-to-Albumin Ratio as A Biomarker of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery. 2021 Mar; 147: e453-8. doi: 10.1016/j.wneu.2020.12.084.

Xie H, Wei L, Liu M, Liang Y, Yuan G, Gao S et al. Neutrophil-Albumin Ratio as A Biomarker For Postoperative Complications and Long-Term Prognosis in Patients with Colorectal Cancer Undergoing Surgical Treatment. Frontiers in Nutrition. 2022 Nov; 9: 976216. doi: 10.3389/fnut.2022.976216.

Shi W, Jiang Y, Tian H, Wang Y, Zhang Y, Yu T et al. C-Reactive Protein-To-Albumin Ratio (CAR) and C-Reactive Protein-To-Lymphocyte Ratio (CLR) are Valuable Inflammatory Biomarker Combination for the Accurate Prediction of Periprosthetic Joint Infection. Infection and Drug Resistance. 2023 Dec; 16: 477-86. doi: 10.2147/IDR.S398958.

Cai C, Zhang B, Sun T, Zhao F, Ma J, Pei X et al. Neutrophil Percentage to Albumin Ratio was Associated with Clinical Outcomes in Coronary Care Unit Patients. Reviews in Cardiovascular Medicine. 2022 Oct; 23(10): 333. doi: 10.31083/j.rcm2310333.

Hu C, He Y, Li J, Zhang C, Hu Q, Li W et al. Association Between Neutrophil Percentage-to-Albumin Ratio and 28-Day Mortality in Chinese patients with sepsis. Journal of International Medical Research. 2023 Jun; 51(6): 03000605231178512. doi: 10.1177/03000605231178512.

Gong Y, Li D, Cheng B, Ying B, Wang B. Increased Neutrophil Percentage-to-Albumin Ratio is Associated with All-Cause Mortality in Patients with Severe Sepsis or Septic Shock. Epidemiology and Infection. 2020 Jan; 148: e87. doi: 10.1017/S0950268820000771.

Gharebaghi N, Valizade Hasanloei MA, Fromandi M, Pashaei MR. Neutrophil-to-Albumin Ratio as A Novel Predictor of Mortality in Patients with Sepsis. Avicenna Journal of Clinical Medicine. 2022 Jun; 29(1): 12-7. doi: 10.52547/ajcm.29.1.12.

He HM, Zhang SC, He C, You ZB, Luo MQ, Lin MQ et al. Association Between Neutrophil Percentage-To-Albumin Ratio and Contrast-Associated Acute Kidney Injury in Patients Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention. Journal of Cardiology. 2022 Feb; 79(2): 257-64. doi: 10.1016/j.jjcc.2021.09.004.

Chen Z, Xie D, Li Y, Dai Z, Xiang S, Chen Z et al. Neutrophil Albumin Ratio Is Associated with All-cause Mortality in Stroke Patients: A Retrospective Database Study. International Journal of General Medicine. 2022 Jan; 15: 1-9. doi: 10.2147/IJGM.S323114.

Wang X, Wang J, Wu S, Ni Q, Chen P. Association Between the Neutrophil Percentage-to-Albumin Ratio and Outcomes in Cardiac Intensive Care Unit Patients. International Journal of General Medicine. 2021 Aug; 14: 4933-43. doi: 10.2147/IJGM.S328882.

Bughio R, Depar K, Ghani A, Depar F, Ahmed E, Depar A. Investigating the Diagnostic Significance of Neutrophil Percentage to Albumin Ratio (NPAR) in Patients with Infectious Meningitis. Journal of Health and Rehabilitation Research. 2024 May; 4(2): 897-904. doi: 10.61919/jhrr.v4i2.969.

Günay AE and Ekici M. Relationship Between Neutrophil/Albumin Ratio and Early Mortality After Major Lower Extremity Amputation. Cureus. 2021 Sep; 13(9). doi: 10.7759/cureus.17733.

Peng Y, Xue Y, Wang J, Xiang H, Ji K, Wang J et al. Association Between Neutrophil-to-Albumin Ratio And Mortality in Patients with Cardiogenic Shock: A Retrospective Cohort Study. British Medical Journal Open. 2020 Oct; 10(10): e039860. doi: 10.1136/bmjopen-2020-039860.

Lv XN, Shen YQ, Li ZQ, Deng L, Wang ZJ, Cheng J et al. Neutrophil Percentage to Albumin Ratio is Associated with Stroke-Associated Pneumonia and Poor Outcome in Patients with Spontaneous Intracerebral Hemorrhage. Frontiers in Immunology. 2023 Jun; 14: 1173718. doi: 10.3389/fimmu.2023.1173718.

Zhou Z, Zhang Y, Pan Y, Yang X, Li L, Gao C et al. A Novel Neutrophil-Based Biomarker to Monitor Disease Activity and Predict Response to Infliximab Therapy in Patients with Ulcerative Colitis. Frontiers in Medicine. 2022 Apr; 9: 872831. doi: 10.3389/fmed.2022.872831.

Bao B, Xu S, Sun P, Zheng L. Neutrophil to Albumin Ratio: A Biomarker in Non-Alcoholic Fatty Liver Disease and With Liver Fibrosis. Frontiers in Nutrition. 2024 Apr; 11: 1368459. doi: 10.3389/fnut.2024.1368459.

Yurteri G and Ada S. Systemic Immune Inflammation Index and Neutrophil to Albumin Ratio Can Predict Left Ventricular Hypertrophy in Geriatric Hemodialysis Patients. Turkish Journal of Geriatrics/Türk Geriatri Dergisi. 2023 Oct; 26(4). doi: 10.29400/tjgeri.2023.366.

Balcioglu YH and Kirlioglu SS. C-reactive Protein/Albumin and Neutrophil/Albumin Ratios As Novel Inflammatory Markers in Patients With Schizophrenia. Psychiatry Investigation. 2020 Sep; 17(9): 902. doi: 10.30773/pi.2020.0185.

Wang R, Tao W, Chen H, Ma T, Cheng X. Investigating Nonlinear Associations Between Neutrophil Percentage to Albumin Ratio and Cardiovascular Disease: A Nationally Representative Cross-Sectional Study. Scientific Reports. 2024 Oct; 14(1): 23632. doi: 10.1038/s41598-024-75111-y.

Çekmen B, Bildik B, Atiş ŞE, Güven H. The Role Of Neutrophil–Albumin Ratio in the Diagnosis of Acute Appendicitis and Its Efficacy in Predicting Perforation. Turkish Journal of Trauma and Emergency Surgery. 2023 Jan; 29(1): 52. doi: 10.14744/tjtes.2022.56570.

Hunter P. The inflammation Theory of Disease: The Growing Realization That Chronic Inflammation Is Crucial in Many Diseases Opens New Avenues for Treatment. European Molecular Biology Organization Reports. 2012 Nov; 13(11): 968-70. doi: 10.1038/embor.2012.142.

Yuan D, Li C, Huang Q, Fu X, Dong H. Current advances in the Anti-inflammatory Effects and Mechanisms of Natural Polysaccharides. Critical Reviews in Food Science and Nutrition. 2023 Aug; 63(22): 5890-910. doi: 10.1080/10408398.2022.2025535.

Kalafati L, Hatzioannou A, Hajishengallis G, Chavakis T. The Role of Neutrophils in Trained Immunity. Immunological Reviews. 2023 Mar; 314(1): 142-57. doi: 10.1111/imr.13142.

Zhang H, Wang Y, Qu M, Li W, Wu D, Cata JP et al. Neutrophil, Neutrophil Extracellular Traps and Endothelial Cell Dysfunction in Sepsis. Clinical and Translational Medicine. 2023 Jan; 13(1): e1170. doi: 10.1002/ctm2.1170.

Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Low Serum Albumin: A Neglected Predictor in Patients with Cardiovascular Disease. European Journal of Internal Medicine. 2022 Aug; 102: 24-39. doi: 10.1016/j.ejim.2022.05.004.

Yang D, Niu C, Li P, Du X, Zhao M, Jing W. Study of the Neutrophil Percentage-ao-Albumin Ratio As A Biomarker for Predicting Recurrence of First-Episode Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases. 2024 Jan; 33(1): 107485. doi: 10.1016/j.jstrokecerebrovasdis.2023.107485.

Karasu M, Karaca Y, Yildirim E, Kobat MA, Er F. Neutrophil-to-albumin Ratio: a Promising Tool for CAD Assessment in Non-ST Elevation AMI. European Review for Medical & Pharmacological Sciences. 2023 Dec; 27(24).

Fan W, Zhang Y, Gao X, Liu Y, Shi F, Liu J et al. The Prognostic Value of A Derived Neutrophil-Lymphocyte Ratio in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Clinical and Applied Thrombosis/Hemostasis. 2021 Jul; 27: 10760296211034579. doi: 10.1177/10760296211034579.

Zawiah M, Khan AH, Abu Farha R, Usman A, AbuHammour K, Abdeen M et al. Predictors of Stroke-Associated Pneumonia and the Predictive Value of Neutrophil Percentage-to-albumin Ratio. Postgraduate Medicine. 2023 Oct; 135(7): 681-9. doi: 10.1080/00325481.2023.2261354.

Dai K, Li Z, Luo Y, Xiong Q, Xiong Y, Song Z et al. Neutrophil Percentage‐to‐albumin Ratio and Monocyte‐to‐lymphocyte Ratio as Predictors of Free‐wall Rupture in Patients with Acute Myocardial Infarction. Journal of Clinical Laboratory Analysis. 2022 Jan; 36(1): e24136. doi: 10.1002/jcla.24136.

Meng Y, Sun J, Zhang G, Yu T, Piao H. Approaches for Neutrophil Imaging: an Important Step in Personalized Medicine. Bioengineered. 2022 Jun; 13(6): 14844-55. doi: 10.1080/21655979.2022.2096303.

Hostačná L, Mašlanková J, Pella D, Hubková B, Mareková M, Pella D. A Multi-Biomarker Approach to Increase the Accuracy of Diagnosis and Management of Coronary Artery Disease. Journal of Cardiovascular Development and Disease. 2024 Aug; 11(9): 258. doi: 10.3390/jcdd11090258.

Liu Z, Dong L, Shen G, Sun Y, Liu Y, Mei J et al. Associations of Neutrophil-Percentage-to-Albumin Ratio Level with All-Cause Mortality and Cardiovascular Disease-Cause Mortality among Patients with Hypertension: Evidence from NHANES 1999–2010. Frontiers in Cardiovascular Medicine. 2024 Jul; 11: 1397422. doi: 10.3389/fcvm.2024.1397422.

Downloads

Published

2024-10-31
CITATION
DOI: 10.54393/pjhs.v5i10.2401
Published: 2024-10-31

How to Cite

Wadood, M., Memon, A., Salman, W., Iftikhar, A., Raza, F., Ahsan, N., & Hussain, M. (2024). Comprehensive Insights into the Neutrophil Percentage to Albumin Ratio (NPAR): An Emerging Integrated Biomarker for Inflammation and Prognosis: Neutrophil Percentage to Albumin Ratio: Emerging Integrated Biomarker for Inflammation. Pakistan Journal of Health Sciences, 5(10), 258–266. https://doi.org/10.54393/pjhs.v5i10.2401

Issue

Section

Systematic Review

Plaudit

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)