ArticleAnatolian journal of cardiology2026
Neutrophil Percentage-to-Albumin Ratio as a Novel Predictor of Diuretic Resistance and Mortality in Patients with Heart Failure with Preserved Ejection Fraction.
Article in Anatolian journal of cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Elevated urinary sodium thresholds in high-salt diet heart failure: implications for diuretic resistance diagnosis.Frontiers in cardiovascular medicine · 2026Article
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Abstract
backgroundHeart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a systemic inflammatory and metabolic disorder. Diuretic resistance remains a major therapeutic challenge in this population. The neutrophil percentage-to-albumin ratio (NPAR), a novel marker of systemic inflammation, may serve as a predictor of diuretic resistance and adverse outcomes in HFpEF.
methodsThis retrospective cohort study included 1 487 HFpEF patients treated between January 2017 and August 2022. Patients were divided into 2 groups: those with and without diuretic resistance. Clinical, laboratory, and echocardiographic parameters were compared between groups. Receiver-operating characteristic (ROC) analysis, logistic regression, and Kaplan-Meier survival analyses were used to determine predictive and prognostic factors.
resultsPatients with diuretic resistance exhibited significantly higher NPAR values, H2FPEF scores, NT-proBNP levels, and echocardiographic indices of diastolic dysfunction. ROC analysis identified an NPAR cut-off of 13.98 for predicting diuretic resistance (AUC = 0.892, 95% CI: 0.741-0.993, P < .01). Multiple Cox's proportional hazard regression analysis revealed that NPAR, hs-C-reactive protein, sodium, NT-proBNP, left atrial volume index, and E/e' were independent predictors of diuretic resistance. Kaplan-Meier analysis demonstrated increased mid-term mortality in patients with NPAR > 13.98 (log-rank P < .001). Elevated NPAR independently predicted mortality in the diuretic-resistant HFpEF subgroup (OR = 1.95, 95% CI: 1.80-2.22, P < .001).
conclusionNPAR is a simple and accessible inflammatory biomarker that independently predicts diuretic resistance and mortality in HFpEF. The findings underscore the role of systemic inflammation in HFpEF pathophysiology and highlight NPAR as a potential tool for early risk stratification and therapeutic decision-making.
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