Niger J Clin Pract. 2026 May 1;29(5):559-566. doi: 10.4103/njcp.njcp_816_25. Epub 2026 May 29.
ABSTRACT
BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease characterized by increased pulmonary vascular resistance, right ventricular failure, and systemic inflammation. Novel biomarkers reflecting disease severity and prognosis are needed for improved risk stratification in PAH.
AIM: To evaluate the relationship between neutrophil percentage-to-albumin ratio (NPAR) and disease severity in patients with Group 1 pulmonary arterial hypertension, and to determine its prognostic value as an inflammatory biomarker.
METHODS: This was a retrospective cohort study conducted on patients with Group 1 PAH. The study included 50 PAH patients (30 New York Heart Association [NYHA] class I-II, 20 class III-IV) and 25 healthy controls without cardiovascular or inflammatory disease for biomarker analysis. Clinical characteristics, laboratory parameters, and echocardiographic data were collected. NPAR was calculated, and its correlation with disease severity and other inflammatory markers was assessed.
RESULTS: High-sensitivity C-reactive protein (hs-CRP) ( P = 0.02), N-Terminal Pro-Brain Natriüretic Peptid (NT-proBNP) ( P = 0.03), NPAR ( P = 0.01), white blood cell (WBC) ( P = 0.03), neutrophil ( P = 0.02), and albumin ( P = 0.02) levels were significantly elevated in PAH patients compared to healthy controls. There was a strong correlation between NPAR and established markers of disease severity, specifically systolic pulmonary artery pressure (sPAP), right atrial (RA) area, NT-proBNP, and 6-min walk distance. According to the receiver operating characteristic (ROC) analysis, an NPAR threshold exceeding 18.2 proved to be a significant predictor for PAH ( P < 0.05) and yielded a sensitivity of 80% and a specificity of 71%, with an area under the curve (AUC) of 0.966 (95% confidence interval (CI): 0.95-0.98). NPAR emerged as an independent predictor of PAH and high-risk PAH in multivariate analysis [1.029 (1.018-1.039), P < 0.01].
CONCLUSION: The study demonstrates that NPAR is a promising biomarker for assessing disease severity and predicting prognosis in PAH. Elevated NPAR levels may reflect systemic inflammation and contribute to the pathogenesis of PAH. Further research is needed to explore the potential therapeutic implications of targeting inflammation in PAH.
PMID:42241205 | DOI:10.4103/njcp.njcp_816_25