Neutrophil percentage-to-albumin ratio as predictor for mortality in patients undergoing endoscopic intervention for variceal hemorrhage

Abstract

BACKGROUND Variceal bleeding (VB) is a serious condition that can lead to increased hospital costs and mortality rates. The neutrophil percentage-to-albumin ratio (NPAR) has been recognized as a predictor of mortality in various diseases. However, the use of NPAR as a predictor of hospital mortality in patients with VB has not been studied previously. AIM To assess the effectiveness of NPAR in predicting mortality in VB patients undergoing endoscopic treatment. METHODS This study included 415 cirrhotic patients who were hospitalized for an upper gastrointestinal bleeding and had endoscopy. NPAR was computed at index admission in blood samples. Using the receiver operator characteristic curve (ROC), the sensitivity and specificity of the NPAR for predicting mortality in patients with VB were calculated. RESULTS Out of 415 cirrhotic patients, 322 patients with variceal bleeding as the sole culprit bleeding lesion were included in the study, while 93 patients with different bleeding lesions were excluded. Among the 322 patients included in the study, 29 (9%) patients died in hospital. The predictors of death for the cases were NPAR (p = 0.0001, AOR: 1.11, 95% CI 1.06-1.16), hospital stay (p = 0.006, AOR: 1.39, 95% CI 1.10-1.76), and pulse rate (p = 0.0001, AOR: 0.936, 95% CI 0.907-0.965). ROC analyses showed that NPAR at a cut-off value of 27.8 had optimal discriminative power for differentiating between alive and deceased cases with a sensitivity of 82.8%, specificity of 65.9%, PPV of 19.4%, NPV of 97.5%, and an accuracy of 67.4% (p < 0.001). CONCLUSIONS NPAR may be a useful predictor of mortality in patients with VB.