Diagnostic and Prognostic Role of Neutrophil Percentage to Albumin Ratio (NPAR) in Systemic Inflammatory and Neoplastic Disorders: A Pathological Insight

Ayesha  Javed; Abdullah  Khan; Razia Asif; Annum  Salim; Saeeda  Bano; Iffat Ara  Aziz; Kshaf Ali Anjum  Khan; Amanullah  Bukhari

doi:10.36283/ziun-pjmd14-4/043

Authors

Ayesha Javed Citi Lab, Main Murree Road, Rawalpindi
Abdullah Khan Jhalawan Medical College, Khuzdar
Razia Asif Bilawal Medical College for Boys, LUMHS, Jamshoro
Annum Salim Chughtai Lab, Karachi
Saeeda Bano Al Nafees Medical College and Hospital, Islamabad campus, Isra University
Iffat Ara Aziz Baqai medical university, Karachi
Kshaf Ali Anjum Khan Akhtar Saeed Medical College, Lahore
Amanullah Bukhari Department of Medicine, RAK College of Medical Sciences, RAK Medical and Health Sciences University, UAE

DOI:

https://doi.org/10.36283/ziun-pjmd14-4/043

Keywords:

Neutrophils / metabolism, Serum Albumin / blood, Biomarkers / diagnostic use, Systemic Inflammatory Response Syndrome / diagnosis, Neoplasms / pathology, Prognosis.

Abstract

Background: Neutrophil percentage to albumin ratio (NPAR) is a new indicator of inflammation and nutrition, and its diagnostic and prognostic potential has yet to be exploited in the inflammatory and neoplastic conditions. The purpose of the study was to determine the clinical usefulness of NPAR as indicator of disease severity and predictor of short-term outcomes of patients of inflammatory and neoplastic diseases.

Methods: In this study, the Pathology department of a tertiary care Akhtar Saeed hospital Lahore admitted 150 patients for the evaluation of possible infections under ethical approval (AST-2312) from October 2024- December 2024. Out of 150, 80 patients had systemic inflammatory diseases (e.g. rheumatoid arthritis) and 70 patients had neoplastic diseases (e.g. colorectal cancer, lymphoma). Complete blood counting and the level of serum albumin were used to calculate NPAR. Its correlation with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), staging of the disease and 3-month clinical outcomes was determined. Using the SPSS version 26.0, statistical significance was p < 0.05.

Results: NPAR was higher in severe inflammatory disease and advanced malignancy with significance p value 0.001 and p 0.0005 respectively. It was correlated with CRP(r = 0.68, p = 0.01) and ESR (r = 0.59, p = 0.02). NPAR had a high diagnostic accuracy in both inflammatory and neoplastic categories with an AUC of 0.801 and 0.842, and sensitivity/specificity of 79.1%/75.0% and 81.4%/76.3 respectively.

Conclusion: NPAR is a potential biomarker with low costs to determine disease severity and short term prognosis of inflammatory and neoplastic diseases. Longitudinal studies should be conducted further.

Author Biographies

Ayesha Javed, Citi Lab, Main Murree Road, Rawalpindi

Department of Haematology
Abdullah Khan, Jhalawan Medical College, Khuzdar

Department of Biochemistry
Razia Asif, Bilawal Medical College for Boys, LUMHS, Jamshoro

Department of Pathology
Annum Salim, Chughtai Lab, Karachi

Department of Hematology
Saeeda Bano, Al Nafees Medical College and Hospital, Islamabad campus, Isra University

Department of Pathology
Iffat Ara Aziz, Baqai medical university, Karachi

Department of Biochemistry
Kshaf Ali Anjum Khan, Akhtar Saeed Medical College, Lahore

Department of Pathology

References

REFERENCES

1. Wadood M, Memon A, Salman W, Iftikhar A, Raza F, Ahsan N, et al. Comprehensive Insights into the Neutrophil Percentage to Albumin Ratio (NPAR): An Emerging Integrated Biomarker for Inflammation and Prognosis: Neutrophil Percentage to Albumin Ratio: Emerging Integrated Biomarker for Inflammation. Pak J Health Sci. 2024 Oct 31:5(10): 258-266. doi: 10.54393/pjhs.v5i10.2401.

2. Li X, Wu M, Chen M, Liu R, Tao Q, Hu Y, et al. The Association Between Neutrophil‐Percentage‐to‐Albumin Ratio (NPAR) and Mortality Among Individuals With Cancer: Insights From National Health and Nutrition Examination Survey. Cancer Med. 2025 Jan;14(2):e70527. doi: 10.1002/cam4.70527

3. Gradel KO. Interpretations of the role of plasma albumin in prognostic indices: a literature review. J Clin Med. 2023 Sep 22;12(19):6132. doi:10.3390/jcm12196132

4. Zhou HH, Tang YL, Xu TH, Cheng B. C-reactive protein: structure, function, regulation, and role in clinical diseases. Front Immunol. 2024 Jun 14;15:1425168. doi:10.3389/fimmu.2024.1425168

5. Cristescu L, Tilea I, Iancu DG, Stoica F, Moldovan DA, Capriglione V, et al. Insights into the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio as predictors for the length of stay and readmission in chronic heart failure patients. Diagnostics. 2024 Sep 23;14(18):2102. doi:10.3390/diagnostics14182102

6. Hou H, Xu Y, Chen G, Yao H, Bi F. Prognostic Value of Systemic Inflammation Response Index and N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries-A Retrospective Study. J Inflamm Res. 2024 Dec 31:8281-8298. doi:10.2147/JIR.S482596.

7. Dong K, Zheng Y, Wang Y, Guo Q. Predictive role of neutrophil percentage-to-albumin ratio, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index for mortality in patients with MASLD. Sci rep. 2024 Dec 5;14(1):30403. doi:10.1038/s41598-024-80801-8

8. Mousa N, Salah M, Elbaz S, Elmetwalli A, Elhammady A, Abdelkader E, et al. Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: a prospective multicenter study. Gut Pathog. 2024 Apr 1;16(1):18. doi:10.1186/s13099-024-00610-2

9. Özbilgeç S, Akkuş F. Cervical Conization and Systemic Inflammatory Markers: The Predictive Value of Neutrophil Percentage to Albumin Ratio (NPAR) to Identify High-Grade Cervical Intraepithelial Neoplasia (CIN). J Inflamm Res.. 2025 Dec 31:5343-5353. doi:10.2147/JIR.S512991

10. Pan J, Li J, Gao Y. The value of 7 peripheral blood serum ratios in diagnosis and prediction of disease activity of patients within inflammatory bowel disease individuals. Front in Med. 2023 Apr 5;10:1122005. doi:10.3389/fmed.2023.1122005

11. Mousa N, Salah M, Elbaz S, Elmetwalli A, Elhammady A, Abdelkader E, et al. Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: a prospective multicenter study. Gut Pathog. 2024 Apr 1;16(1):18. doi: 10.1186/s13099-024-00610-2.

12. Zhang H, Wu T, Tian X, Lyu P, Wang J, Cao Y. High Neutrophil Percentage-To-Albumin Ratio Can Predict Occurrence of Stroke-Associated Infection. Front Neurol. 2021 Sep 8;12:705790. doi: 10.3389/fneur.2021.705790.

13. Wang X, Wang J, Wu S, Ni Q, Chen P. Association Between the Neutrophil Percentage-to-Albumin Ratio and Outcomes in Cardiac Intensive Care Unit Patients. Int J Gen Med. 2021 Aug 28;14:4933-4943. doi: 10.2147/IJGM.S32888

14. Huang X, Zhang Y, Hao W, Wu X, Yang P. The association between neutrophil percentage-to-albumin ratio and cardiovascular disease: evidence from a cross-sectional study. Front Cardiovasc Med. 2025 May 14;12:1557507. doi:10.3389/fcvm.2025.1557507

15. Zang SW, Long JJ, Wang Y. Neutrophil Percentage to Albumin Ratio as a Predictor for Coronary Slow Flow Phenomenon in Patients with Myocardial Ischemia with No Obstructive Coronary Arteries. Int J Gen Med. 2024 Aug 14;17:3511-3519. doi: 10.2147/IJGM.S477431.

16. Wang R, Tao W, Chen H, Ma T, Cheng X. Investigating nonlinear associations between neutrophil percentage to albumin ratio and cardiovascular disease: a nationally representative cross-sectional study. Sci Rep. 2024 Oct 9;14(1):23632. doi: 10.1038/s41598-024-75111-y.

17. Jing Y, Tian B, Deng W, Ren Z, Xu X, Zhang D, et al. The Neutrophil Percentage-to-Albumin Ratio as a Biomarker for All-Cause and Diabetes-Cause Mortality Among Diabetes Patients: Evidence From the NHANES 1988-2018. J Clin Lab Anal. 2024 Nov;38(21):e25110. doi: 10.1002/jcla.25110.

18. Lan CC, Su WL, Yang MC, Chen SY, Wu YK. Predictive role of neutrophil-percentage-to-albumin, neutrophil-to-lymphocyte and eosinophil-to-lymphocyte ratios for mortality in patients with COPD: Evidence from NHANES 2011-2018. Respirology. 2023 Dec;28(12):1136-1146. doi: 10.1111/resp.14589.

19. Miyamoto Y, Akiyama T, Kato R, Sawayama H, Ogawa K, Yoshida N, et al. Prognostic significance of systemic inflammation indices by K-ras Status in patients with metastatic colorectal Cancer. Dis Colon Rectum. 2023 Aug 1;66(8):e809-817. doi: 10.1097/DCR.0000000000002392

20. Tojek K, Banaś W, Czerniak B, Kowalczyk G, Szukay B, Korzycka-Wilińska W, et al. Total blood lymphocyte count as a prognostic factor among unselected inpatients. Adv Med Sci. 2020 Mar 1;65(1):141-148. doi:10.1016/j.advms.2020.01.001

21. Ko CA, Fang KH, Tsai MS, Lee YC, Lai CH, Hsu CM, et al. Prognostic Value of Neutrophil Percentage-to-Albumin Ratio in Patients with Oral Cavity Cancer. Cancers (Basel). 2022 Oct 6;14(19):4892. doi: 10.3390/cancers14194892.

22. Du X, Wei X, Ma L, Liu X, Guo H, Liu Y, et al. Higher levels of neutrophil percentage-to-albumin ratio predict increased mortality risk in patients with liver cirrhosis: a retrospective cohort study. Eur J Gastroenterol Hepatol. 2023 Feb 1;35(2):198-203. doi: 10.1097/MEG.0000000000002470.

23. Cucoranu DC, Pop M, Niculescu R, Kosovski IB, Toganel RO, Licu RA, et al. The Association of Nonalcoholic Fatty Liver Disease With Neutrophil-to-Lymphocyte Ratio and Neutrophil-Percentage-to-Albumin Ratio. Cureus. 2023 Jun 30;15(6):e41197. doi: 10.7759/cureus.41197.

24. Yang D, Niu C, Li P, Du X, Zhao M, Jing W. Study of the neutrophil percentage-to-albumin ratio as a biomarker for predicting recurrence of first-episode ischemic stroke. J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107485. doi: 10.1016/j.jstrokecerebrovasdis.2023.107485.

25. Hou F, Zhang Q, Zhang W, Xiang C, Zhang G, Wang L, et al. A correlation and prediction study of the poor prognosis of high-grade aneurysmal subarachnoid hemorrhage from the neutrophil percentage to albumin ratio. Clin Neurol Neurosurg. 2023 Jul;230:107788. doi: 10.1016/j.clineuro.2023.107788.