Neutrophil-to-prognostic nutritional index ratio and short-term mortality in heart failure: an exploratory association without demonstrated superiority over PNI, NLR, or SII
- 1Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
- 2Department of Pediatrics/Neonatology, Hebei General Hospital, Shijiazhuang, China
Abstract
BackgroundSystemic inflammation and greater illness severity are associated with adverse short-term outcomes in heart failure (HF). The neutrophil-to-prognostic nutritional index ratio (NPNR) combines neutrophil count with the prognostic nutritional index (PNI), a composite derived from serum albumin and lymphocyte count that is influenced by inflammation and acute illness. This study examined the association of NPNR with 28-day and 90-day all-cause mortality in hospitalized patients with HF and assessed its replication in MIMIC-IV.MethodsThe analysis included 1,885 patients with calculable NPNR from the Zigong Heart Failure Database and 1,150 adult ICU patients with HF from MIMIC-IV. Log2-transformed NPNR was examined using Cox regression, Kaplan–Meier analysis, restricted cubic splines (RCS), and sensitivity analyses, including parsimonious and Firth-penalized Cox models. MIMIC-IV provided an independent clinical setting for assessing the direction of the association.ResultsIn Zigong, each doubling of NPNR was associated with higher 28-day mortality (HR 1.728, 95% CI 1.130–2.642, p = 0.012) and 90-day mortality (HR 1.684, 95% CI 1.124–2.524, p = 0.012). However, the expanded models included only 32 and 36 deaths, respectively, and the tertile-based estimates had wide confidence intervals. RCS analyses suggested nonlinearity at both time horizons. NPNR AUCs were 0.727 and 0.717, with no significant superiority over PNI, NLR, or SII in DeLong comparisons. In MIMIC-IV, the continuous association was borderline significant at 28 days (HR 1.112, p = 0.049) and not statistically significant at 90 days (HR 1.081, p = 0.096). Higher NPNR tertiles were associated with greater mortality, while RCS analyses showed no clear nonlinearity.ConclusionHigher NPNR was associated with short-term all-cause mortality in the Zigong HF cohort, with weaker evidence in the MIMIC-IV ICU cohort. NPNR may be considered an exploratory laboratory-derived marker associated with systemic inflammation and illness severity. It did not demonstrate superior discrimination over PNI, NLR, or SII, and its incremental prognostic value remains uncertain. These findings do not support its routine use as a clinical decision tool.
Related
- ASSOCIATION BETWEEN NEUTROPHIL-PLATELET AGGREGATES, TUMOR STAGING AND NUTRITIONAL STATUS IN GASTRIC CANCER PATIENTS
- Short-term superiority in proteinuria control with exploratory longitudinal trajectories: finerenone-dapagliflozin combination in non-diabetic kidney disease
- Association between neutrophil percentage-to-albumin ratio and all-cause mortality in stroke survivors stratified by triglyceride-glucose index : A prospective observational study based on the NHANES database from 1999 to 2018
- Sex-Specific Cross-Sectional Associations and Exploratory Mediation Analysis of Cardiovascular Disease Risk by Neutrophil-to-Lymphocyte Ratio in Cadmium-Exposed Populations.
- Age, residential, and socioeconomic differences in the association between nutritional literacy and physical activity among adults
BibTeX
@article{yuan2026neutrophiltoprognostic,
title = {{Neutrophil-to-prognostic nutritional index ratio and short-term mortality in heart failure: an exploratory association without demonstrated superiority over PNI, NLR, or SII}},
author = {Zhenyu Yuan and Mohan Li and Lei Zhao and Hong Geng and Qiang Ji and Kun Zuo and Yuanzhi Luo and Guanli Liang and Gengxu He},
journal = {Frontiers in Nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1995940},
url = {https://doi.org/10.3389/fnut.2026.1995940},
note = {CC BY},
}
RIS
TY - JOUR
TI - Neutrophil-to-prognostic nutritional index ratio and short-term mortality in heart failure: an exploratory association without demonstrated superiority over PNI, NLR, or SII
AU - Zhenyu Yuan
AU - Mohan Li
AU - Lei Zhao
AU - Hong Geng
AU - Qiang Ji
AU - Kun Zuo
AU - Yuanzhi Luo
AU - Guanli Liang
AU - Gengxu He
PY - 2026
DA - 2026/10/23
JO - Frontiers in Nutrition
DO - 10.3389/fnut.2026.1995940
UR - https://doi.org/10.3389/fnut.2026.1995940
AB - BackgroundSystemic inflammation and greater illness severity are associated with adverse short-term outcomes in heart failure (HF). The neutrophil-to-prognostic nutritional index ratio (NPNR) combines neutrophil count with the prognostic nutritional index (PNI), a composite derived from serum albumin and lymphocyte count that is influenced by inflammation and acute illness. This study examined the association of NPNR with 28-day and 90-day all-cause mortality in hospitalized patients with HF and assessed its replication in MIMIC-IV.MethodsThe analysis included 1,885 patients with calculable NPNR from the Zigong Heart Failure Database and 1,150 adult ICU patients with HF from MIMIC-IV. Log2-transformed NPNR was examined using Cox regression, Kaplan–Meier analysis, restricted cubic splines (RCS), and sensitivity analyses, including parsimonious and Firth-penalized Cox models. MIMIC-IV provided an independent clinical setting for assessing the direction of the association.ResultsIn Zigong, each doubling of NPNR was associated with higher 28-day mortality (HR 1.728, 95% CI 1.130–2.642, p = 0.012) and 90-day mortality (HR 1.684, 95% CI 1.124–2.524, p = 0.012). However, the expanded models included only 32 and 36 deaths, respectively, and the tertile-based estimates had wide confidence intervals. RCS analyses suggested nonlinearity at both time horizons. NPNR AUCs were 0.727 and 0.717, with no significant superiority over PNI, NLR, or SII in DeLong comparisons. In MIMIC-IV, the continuous association was borderline significant at 28 days (HR 1.112, p = 0.049) and not statistically significant at 90 days (HR 1.081, p = 0.096). Higher NPNR tertiles were associated with greater mortality, while RCS analyses showed no clear nonlinearity.ConclusionHigher NPNR was associated with short-term all-cause mortality in the Zigong HF cohort, with weaker evidence in the MIMIC-IV ICU cohort. NPNR may be considered an exploratory laboratory-derived marker associated with systemic inflammation and illness severity. It did not demonstrate superior discrimination over PNI, NLR, or SII, and its incremental prognostic value remains uncertain. These findings do not support its routine use as a clinical decision tool.
SN - 2296-861X
ER -