Albumin/Neutrophil-Lymphocyte Ratios and All-Cause and Cardiovascular Mortality in Atherosclerotic Patients
Zicong Ye, Chunyu Zhu, Jiazhen DaiBackground
Serum albumin (ALB) and neutrophil-to-lymphocyte ratio (NLR) are linked to adverse cardiovascular outcomes, but few studies have used ALB/NLR (ANLR) to assess mortality risk in atherosclerotic cardiovascular disease (ASCVD). This study evaluated the nonlinear association between ANLR and all-cause mortality (ACM) and cardiovascular mortality (CVM) in ASCVD patients.
Methods
This study was grounded in data from the National Health and Nutrition Examination Survey spanning 1999 to 2018.
Results
The study cohort comprised 2,918 participants. During the follow-up period, 1,231 all-cause deaths and 454 cardiovascular deaths occurred. Kaplan-Meier survival analysis showed that a lower ANLR (Q1) was associated with worse survival outcomes (ACM and CVM: log-rank test P < 0.001). Multivariate Cox regression showed a significant inverse association between ANLR and the risk of ACM (hazard ratio [HR] = 0.883, 95% confidence interval [CI]: 0.810-0.964, P = 0.005). After ANLR was grouped according to quartiles, the risk of CVM in the Q2-Q4 groups was significantly lower than that in the Q1 group. Restricted cubic spline analysis further revealed a nonlinear negative link between ANLR and the risk of ACM (P for nonlinear < 0.001), and the risk rose sharply when ANLR < 1.8, suggesting this value may be a practical cutoff for identifying high-risk individuals. Additionally, the elevated risk observed at ANLR > 3.816 may reflect a U-shaped association rather than measurement error alone.
Conclusions
ANLR was significantly and negatively associated with the risk of ACM and CVM in ASCVD, and there was a nonlinear threshold effect. This finding provides an economical biomarker for identifying high-risk individuals and assessing the prognosis of ASCVD. Nonetheless, longitudinal studies are needed to verify these findings.