Predictive significance of the neutrophil percentage-to-albumin ratio in post-percutaneous coronary intervention contrast-induced nephropathy among type 2 diabetes mellitus patients with chronic coronary syndrome

Abstract

Background: Contrast-induced nephropathy (CIN) remains a common and serious complication following percutaneous coronary intervention (PCI), particularly among patients with type 2 diabetes mellitus and chronic coronary syndrome (CCS). Inflammation plays a central role in CIN pathogenesis, yet practical and reliable inflammatory biomarkers for routine risk stratification are limited. The neutrophil percentage-to-albumin ratio (NPAR) has recently emerged as a novel marker of systemic inflammation. Objective: To investigate the predictive value of NPAR for the development of CIN and in-hospital mortality in patients with type 2 diabetes mellitus and CCS undergoing elective PCI, and to compare its performance with established inflammatory indices. Methods: This retrospective study included 388 consecutive patients with type 2 diabetes mellitus and CCS who underwent elective PCI. Patients were stratified into tertiles based on NPAR values. CIN was defined as an increase in serum creatinine >= 0.3 mg/dL or >= 50% within 48 h after PCI. Multivariate logistic regression analyses were performed to identify independent predictors of CIN and in-hospital mortality. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory ability of NPAR. Results: The incidence of CIN and in-hospital mortality increased significantly across rising NPAR tertiles (P < 0.01). The number of patients with CIN of the low-, medium-and high-NPAR groups were 17 (2.8%), 13 (10.3%), and 28 (23.7%), respectively. In multivariate analysis, NPAR was independently associated with CIN (adjusted OR 1.18; 95% CI (1.08-1.28); P < 0.01) and in-hospital mortality (adjusted OR 1.16; 95% CI (1.08-1.24); P < 0.01). ROC analysis demonstrated good predictive performance of NPAR for CIN (AUC 0.820; 95% CI 0.700-0.940; P < 0.01), with an optimal cutoff value of 19.8. NPAR showed superior discriminatory ability compared with the neutrophil-to-lymphocyte ratio. Conclusion: Elevated NPAR is independently associated with an increased risk of CIN and in-hospital mortality in patients with type 2 diabetes mellitus and CCS undergoing elective PCI. As a simple, inexpensive, and readily available inflammatory marker, NPAR may serve as a useful adjunctive tool for pre-procedural risk stratification.