AIM To explore the predictive value of the neutrophil-to-albumin ratio (NPAR) for the onset of type I cardiorenal syndrome (CRS-1) in patients with acute coronary syndrome (ACS) under different glucose metabolic conditions.
METHODS A retrospective analysis was conducted of the clinical data from patients diagnosed with ACS admitted to the Cardiology Department of Wuhan Third Hospital from January 2018 to October 2023. The patients were divided into non-CRS-1 (1190 cases) and CRS-1 group (161 cases) based on the occurrence of CRS-1 and they were further categorized into three subgroups according to NPAR values. Binary logistic regression analysis was employed to investigate the predictive role of NPAR for CRS-1 and its predictive value was assessed using the receiver operating characteristic (ROC) curve. Binary logistic regression analysis was used to determine the risk levels across different glucose metabolism groups, calculating the area under the curve (AUC) of the ROC and the 95% CI to ascertain the accuracy of NPAR in detecting CRS-1 in ACS patients under varying glucose metabolic states.
RESULTS Compared with patients without CRS-1, the percentage of lymphocytes and albumin in CRS-1 patients decreased, and the difference was statistically significant (both P<0.01). Glycated hemoglobin (P<0.05), C-reactive protein (P<0.01), creatinine (P<0.01), cystatin C (P<0.01), and NPAR (neutrophil percentage/albumin) all increased, and the differences were statistically significant. ACS patients with CRS-1 are older (P<0.05), more common in females (P<0.01), and have higher alcohol consumption history, hypertension history, FPG, neutrophil percentage, and lymphocyte percentage indicators (all P<0.01). NPAR has predictive value for the occurrence of CRS-1 in the patients in this study sample, with an OR value of 2.271 (1.476~3.496). Through ROC curve testing, its AUC value is 0.691 (95% CI: 0.650~0.731). By adjusting for confounding factors in different glucose metabolism states, the OR value of the DM group was 6.132 (3.081~12.204), which was the highest, and its AUC value of 0.710 (95% CI: 0.655~0.765) was the most predictive. In addition, the percentage of neutrophils and the area under the ROC curve (AUC) of albumin were smaller than those of NPAR.
CONCLUSION NPAR demonstrates considerable predictive value for the onset of CRS-1 in ACS patients. Upon analyzing different glucose metabolic states, NPAR exhibits enhanced predictive value within the DM group.
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