ArticleFrontiers in medicine2026
Association of NPAR with 90-day mortality in predominantly acute-on-chronic liver failure.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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4 authors.
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Abstract
Background: Acute-on-chronic liver failure (ACLF) carries high short-term mortality, and easily available prognostic biomarkers are urgently needed. The neutrophil percentage-to-albumin ratio (NPAR) integrates inflammatory and nutritional status, but its prognostic value in liver failure remains unclear. This study aimed to investigate the association between NPAR and 90-day mortality in patients with liver failure, hypothesizing that elevated NPAR would be associated with worse outcomes. Methods: This retrospective cohort study included 104 adult patients with liver failure (89.4% ACLF) admitted from January 2022 to December 2024. NPAR was calculated as neutrophil percentage divided by albumin concentration. The primary outcome was 90-day mortality. We used log-transformed NPAR in regression analyses to improve model stability. Multivariable logistic regression was performed with MELD score as the sole covariate in a parsimonious two-predictor model, with bootstrap validation (1,000 iterations). Formal tests for interaction were conducted to assess potential effect modification by sex, age (<60 vs. ≥60 years), and ascites status. Results: Of 104 patients, 29 (27.9%) died within 90 days. The non-survival group had significantly higher NPAR levels [median 2.51 (IQR: 2.17-2.82) vs. 1.88 (1.61-2.29), Conclusions: After adjustment for MELD score, no statistically significant independent association was demonstrated between ln-NPAR and 90-day mortality (adjusted OR: 1.66, 95% CI: 0.40-6.82). Whether NPAR provides incremental prognostic information beyond established severity scores remains to be determined in larger studies. These findings primarily apply to a predominantly ACLF population.
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