Admission neutrophil percentage-to-albumin ratio is associated with poor steroid response in idiopathic sudden sensorineural hearing loss

Abstract

Objective: Sudden sensorineural hearing loss (SSNHL) is an otological emergency with an unpredictable prognosis. Reliable and accessible prognostic markers are needed. This study explored the prognostic value of the neutrophil percentage-to-albumin ratio (NPAR) in idiopathic SSNHL. Methods: This retrospective cohort study included 62 patients with SSNHL presenting within 10 days of symptom onset and 64 age- and sex-matched healthy controls. Patients with major systemic inflammatory or metabolic diseases were excluded. NPAR was calculated from admission laboratory parameters. The primary analysis compared responders and non-responders within the SSNHL cohort; the comparison with healthy controls served as secondary context. Treatment response was assessed by pure-tone audiometry on day 10 according to Siegel's criteria. Given the limited number of outcome events, a reduced, pre-specified multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed and interpreted as exploratory. Results: NPAR was significantly higher in non-responders (22.1 [19.6-29.7]) than responders (18.1 [16.6-22.7]), and higher in SSNHL patients than controls. In a pre-specified multivariable model, NPAR was independently associated with treatment non-improvement (OR 2.55, 95% CI 1.55-3.55; p = 0.01). In exploratory ROC analysis, NPAR showed moderate discriminative ability (AUC = 0.82, 95% CI 0.70-0.94), with an internally derived cutoff of 21.9 (sensitivity 70%, specificity 76%). The wide confidence interval reflects the limited sample size, and these findings should be interpreted as preliminary and hypothesis-generating. Conclusion: In this exploratory single-centre study, NPAR an inexpensive, routinely available marker was associated with poor treatment response in idiopathic SSNHL. These preliminary findings require external validation before any clinical application. To our knowledge, this is the first study to evaluate NPAR in idiopathic SSNHL.