ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Respiratory Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1582120
This article is part of the Research TopicTranslational Strategies for Chronic Lung Diseases: Emerging Therapies and Precision MedicineView all 7 articles
NHANES-Based Assessment of Neutrophil-Percentage-to-Albumin and Neutrophilto-Lymphocyte Ratios as Moderate Predictors of Mortality in Adults with Chronic Respiratory Diseases
Provisionally accepted
Feng Xu*
Pan Jiang- Shenzhen Guangming District People's Hospital, Shenzhen, China
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Objective: This study aimed to evaluate the predictive roles of hematologic inflammatory biomarkers, including the neutrophil-percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), and eosinophil-to-lymphocyte ratio (ELR), in relation to mortality among individuals with chronic respiratory diseases (CRDs).We analyzed data from the National Health and Nutrition Examination Survey (NHANES) to assess the relationship between these inflammatory biomarkers and mortality in adults with CRDs. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality, adjusting for potential confounders.Receiver operating characteristic (ROC) curve analysis was employed to evaluate the predictive performance of these biomarkers, with the area under the curve (AUC) used to compare their accuracy.Results: A total of 8,387 participants with CRDs were included in the analysis. Higher levels of NPAR were significantly associated with increased all-cause mortality (HR = 1.33, 95% CI: 1.26-1.40, P < 0.001). Similarly, elevated NLR was associated with higher mortality risk (HR = 1.24, 95% CI: 1.17-1.30, P < 0.001). In contrast, ELR did not show a significant association with mortality (HR = 1.04, 95% CI: 0.99-1.10, P = 0.098). ROC curve analysis revealed that NPAR had the highest AUC value (0.639, 95% CI: 0.623-0.656), suggesting modest yet relatively better discriminative capacity among the evaluated biomarkers for mortality risk stratification.Among individuals with chronic respiratory diseases, higher NPAR and NLR are significant predictors of mortality, with statistically significant but moderate predictive ability as indicated by their AUC values. These findings suggest that NPAR and NLR may serve as useful biomarkers for risk stratification in patients with CRDs, though their clinical utility is limited by modest predictive power.
Keywords: neutrophil-percentage-to-albumin ratio, Neutrophil-to-lymphocyte ratio, eosinophil-to-lymphocyte ratio, Mortality, Asthma, NHANES
Received: 24 Feb 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Xu and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Feng Xu, Shenzhen Guangming District People's Hospital, Shenzhen, China
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