# Verhoogde NPAR voorspelt alle-oorzaak sterfte na beroerte, vooral bij insulineresistentie

*geplaatst 2026-10-16 · Cholesterol · Medicine · doi 10.1097/MD.0000000000050968 · https://hartvaat.nl/2026/10/09/verhoogde-npar-voorspelt-alle-oorzaak-sterfte-na-beroerte-vooral-bij-insulineres/*

Een prospectieve cohortstudie onder 1187 beroerteoverlevenden uit NHANES (1999-2018) toont aan dat een verhoogde neutrofiel-ten-albumine ratio (NPAR) significant samenhangt met alle-oorzaak sterfte, met name bij patiënten met een matige tot hoge insulineresistentie (TyG-index). In de multivariaat gecorrigeerde modellen was de hoogste NPAR-tertiel geassocieerd met een verhoogd sterfterisico (HR 1,18 bij matige en HR 1,10 bij hoge insulineresistentie), terwijl dit in de groep met lage insulineresistentie niet significant was. Deze bevindingen suggereren dat NPAR, gecombineerd met TyG-stratificatie, kan helpen bij het verfijnen van het risicoprofiel en de opvolging van beroerteoverlevenden in de dagpraktijk.

## English: Association between neutrophil percentage-to-albumin ratio and all-cause mortality in stroke survivors stratified by triglyceride-glucose index: A prospective observational study based on the NHANES database from 1999 to 2018.

A prospective observational study of 1,187 stroke survivors from NHANES (1999–2018) demonstrates that a higher neutrophil percentage-to-albumin ratio (NPAR) is significantly associated with all-cause mortality, particularly among patients with moderate to high insulin resistance (TyG index). In multivariable-adjusted models, the highest NPAR tertile correlated with increased mortality risk (HR 1.18 in moderate and HR 1.10 in high insulin resistance groups), whereas no significant association was found in the low insulin resistance cohort. These findings suggest that monitoring NPAR alongside TyG-based metabolic stratification could refine risk assessment and guide follow-up strategies for stroke survivors.

## Abstract (original, from the publication)

The neutrophil percentage-to-albumin ratio (NPAR) is a novel inflammatory biomarker with prognostic value in critical illnesses, but its association with outcomes in stroke survivors remains unclear. No prior study has explored whether this association differs across triglyceride-glucose index (TyG) strata, a surrogate marker of insulin resistance (IR) and metabolic disturbance in cardiovascular disease. Data from the National Health and Nutrition Examination Survey 1999 to 2018 were analyzed for 1187 stroke survivors aged 40 to 80 years. Kaplan-Meier curves, multivariate Cox models, restricted cubic spline (RCS) analysis, and subgroup analyses were used to examine the relationship between baseline NPAR and all-cause mortality across TyG levels. Over a median follow-up of 86 months, 496 (41.79%) of the 1187 participants died; median survival was 133 months. Kaplan-Meier analysis showed significant mortality differences across NPAR tertiles in all participants and within intermediate- and high-IR groups (all P < .001). As a continuous variable, NPAR was significantly associated with mortality in the intermediate-risk (hazard ratio = 1.18) and high-risk (hazard ratio = 1.10) groups, but not in the low-risk group. As a categorical variable, the highest NPAR tertile (T3) was associated with higher mortality across all adjustment models in IR intermediate- and high-risk groups, whereas in the IR low-risk group, significance was observed only in the minimally adjusted model. Restricted cubic spline analysis revealed a linear association between NPAR and mortality in all participants (P for nonlinear = .291), as well as in IR intermediate- and high-risk groups, but no association in the IR low-risk group (P for overall = .187). Subgroup analyses showed significant interactions across TyG subgroups (P for interaction = .047). Two sensitivity analyses confirmed the stability of the main findings. Monitoring NPAR levels alongside TyG-based stratification may facilitate comprehensive risk assessment and inform targeted management strategies for stroke survivors.

Auteurs: Ning Liu, Zhongzhou Su, Sheng Zhang

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Bron: Medicine, https://doi.org/10.1097/MD.0000000000050968. Bijgewerkt 2026-10-10T01:05:36Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.