Association between neutrophil percentage-to-albumin ratio and mortality in patients with community acquired pneumonia receiving systemic glucocorticoids :a retrospective cohort study

Juan Guo¹Chun Jing Jiang²Juan You Ran^3*Li Tang^1*

• ¹Department of Respiratory Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
• ²Department of Neurology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
• ³Department of Central Sterile Supply, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China

Background:The ratio of neutrophil percentage to albumin (NPAR) has been recognized as an inflammatory indicator for predicting the prognosis of various diseases. Nevertheless, no research has explored the relationship between NPAR and prognosis in patients who develop community acquired pneumonia (CAP) during long-term and systemic glucocorticoids therapy. Therefore,this study aims to investigate the association between NPAR on admission and mortality in the aforementioned patients. Method:The data of this study were extracted from the Dryad database. An analysis was conducted data from patients diagnosed with CAP who had received either oral or intravenous glucocorticoids before hospital admission. Patients were categorized into three groups based on their NPAR levels upon admission. Kaplan-Meier survival curves, multivariable Cox regression models, restricted cubic spline curves, and subgroup analyses were performed to evaluate the association between the NPAR and 30-day as well as 90-day mortality in these patients, respectively. Sensitivity analysis were performed to verify the stability of the results. Results:Among the 570 patients diagnosed with CAP incorporated into the study, the 30-day and 90-day mortality were 21. 9% and 24. 9%, respectively. The study revealed that the NPAR exhibited a significantly positive correlation with mortality. Multivariable Cox regression analyses, after adjustment for all possible confounders, indicated that a higher NPAR level was correlated with an elevated risk of 30-day mortality(HR: 1. 21, 95%CI: 1. 14-1. 28). Compared with patients in tertile 1, those in tertile 2 and tertile 3 exhibited a notably increased risk of 30-day mortality(HR: 1. 83, 95%CI: 1. 38-2. 43; HR: 3. 19, 95%CI: 2. 72-4. 2, respectively). Analogous findings were also observed for 90-day mortality. Kaplan-Meier survival curves showed that the highest tertile had the lowest survival rates for 30-day and 90-day mortality. Additionally, subgroup analysis revealed no interactions and demonstrated robust results across different subgroups. A linear relationship was observed between NPAR and mortality. Conclusions: Higher level of NPAR was significantly associated with an increased risk of 30-day and 90-day mortality in patients with community acquired pneumonia receiving systemic glucocorticoids therapy.