Fibrinogen-to-Albumin Ratio is Associated with All-Cause Mortality in Cancer Patients

Figures & data

Table 1 Characteristics of the Study Patients According to Neutrophil Percentage-to-Albumin Ratios

Characteristics	Neutrophil Percentage-to-Albumin Ratios
	<20.5 (n = 313)	≥20.5, <25.0 (n = 313)	≥25.0 (n = 314)	P value
Age, years	66.5 ± 14.8	67.2 ± 15.0	67.0 ± 14.2	0.839
Gender, n (%)				0.893
Female	139 (44.4)	140 (44.7)	145 (46.2)
Male	174 (55.6)	173 (55.3)	169 (53.8)
Ethnicity, n (%)				0.328
White	221 (70.6)	224 (71.6)	224 (71.3)
Black	34 (10.9)	20 (6.4)	28 (8.9)
Other	58 (18.5)	69 (22.0)	62 (19.7)
NPAR	16.7 ± 4.2	22.6 ± 1.3	31.3 ± 7.1	<0.001
SBP, mmHg	130.5 ± 17.8	129.4 ± 17.5	121.4 ± 17.7	<0.001
DBP, mmHg	64.5 ± 11.1	64.8 ± 11.7	61.5 ± 11.0	<0.001
MBP, mmHg	83.5 ± 11.4	83.7 ± 12.0	79.3 ± 11.3	<0.001
Heart rate, beats/minute	80.4 ± 16.2	81.8 ± 14.5	87.6 ± 17.4	<0.001
Respiratory rate, beats/minute	18.4 ± 3.5	18.4 ± 3.4	20.3 ± 4.7	<0.001
Temperature, °C	36.9 ± 0.6	37.0 ± 0.6	36.9 ± 0.8	0.861
SPO2, %	97.5 ± 1.9	97.8 ± 2.1	97.5 ± 2.6	0.307
Comorbidities, n (%)
Congestive heart failure	28 (8.9)	26 (8.3)	52 (16.6)	0.001
Coronary artery disease	43 (13.7)	64 (20.4)	56 (17.8)	0.082
Atrial fibrillation	84 (26.8)	90 (28.8)	108 (34.4)	0.100
Renal disease	27 (8.6)	35 (11.2)	64 (20.4)	<0.001
Liver disease	13 (4.2)	10 (3.2)	22 (7.0)	0.067
Pneumonia	72 (23.0)	84 (26.8)	126 (40.1)	<0.001
Malignancy	52 (16.6)	38 (12.1)	48 (15.3)	0.267
Respiratory failure	79 (25.2)	101 (32.3)	184 (58.6)	<0.001
COPD	1 (0.3)	3 (1.0)	4 (1.3)	0.416
Laboratory parameters
Neutrophil percentage, %	66.9 ± 18.9	83.3 ± 7.5	85.4 ± 7.2	<0.001
Albumin, g/dl	4.0 ± 0.6	3.7 ± 0.4	2.8 ± 0.5	<0.001
Bicarbonate, mg/dl	25.8 ± 3.7	25.3 ± 3.5	24.3 ± 4.8	<0.001
Anion gap, mmol/l	16.8 ± 3.8	16.9 ± 3.8	17.5 ± 5.1	0.110
Creatinine, mEq/l	1.4 ± 2.5	1.5 ± 1.8	2.0 ± 1.7	<0.001
Chloride, mmol/l	106.6 ± 6.1	107.2 ± 6.7	108.8 ± 7.4	<0.001
Glucose, mg/dl	178.5 ± 87.1	192.5 ± 81.9	196.7 ± 94.2	0.025
Hematocrit, %	38.3 ± 6.1	38.3 ± 5.3	35.2 ± 6.1	<0.001
Hemoglobin, g/dl	13.0 ± 2.1	13.0 ± 1.9	11.7 ± 2.2	<0.001
Platelet, 10^9 /l	246.3 ± 112.6	258.6 ± 105.3	250.6 ± 144.0	0.446
Sodium, mmol/l	141.5 ± 5.3	141.6 ± 5.4	141.5 ± 5.6	0.972
Potassium, mmol/l	4.4 ± 0.8	4.4 ± 0.8	4.7 ± 0.9	<0.001
BUN, mg/dl	24.1 ± 19.1	24.4 ± 16.7	38.5 ± 29.3	<0.001
WBC, 10^9 /l	13.9 ± 21.5	14.0 ± 6.1	15.9 ± 8.9	0.109
PT, second	15.9 ± 9.2	15.8 ± 9.1	20.0 ± 14.4	<0.001
APTT, second	35.4 ± 21.2	37.1 ± 26.4	50.2 ± 36.5	<0.001
INR	1.5 ± 1.2	1.5 ± 1.4	2.0 ± 1.9	<0.001
Scoring systems
APSIII	42.9 ± 19.9	43.3 ± 20.0	57.9 ± 24.8	<0.001
SAPSII	35.9 ± 13.8	38.4 ± 13.1	46.4 ± 14.6	<0.001
30-day mortality, n (%)	67 (21.4)	77 (24.6)	100 (31.8)	0.009
90-day mortality, n (%)	78 (24.9)	92 (29.4)	125 (39.8)	<0.001
365-day mortality, n (%)	97 (31.0)	107 (34.2)	145 (46.2)	<0.001

Abbreviations: NPAR, neutrophil percentage-to-albumin ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure; COPD, chronic obstructive pulmonary disease; BUN, blood urea nitrogen; WBC, white blood cell; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio; APSIII, acute physiology score III; SAPSII, Simplified Acute Physiology Score II.

Table 2 HRs (95% CIs) for All-Cause Mortality Across Groups of Neutrophil Percentage-to-Albumin Ratios

NAR	Non-Adjusted		Model I		Model II
	HR (95% CIs)	P value	HR (95% CIs)	P value	HR (95% CIs)	P value
30-day all-cause mortality
Tertiles
<20.5	1.0(ref)		1.0(ref)		1.0(ref)
≥20.5, <25.0	1.17 (0.85, 1.63)	0.3389	1.11 (0.80, 1.55)	0.5175	1.10 (0.79, 1.54)	0.5670
≥25.0	1.55 (1.13, 2.11)	0.0058	1.52 (1.11, 2.07)	0.0083	1.45 (1.05, 2.00)	0.0254
P trend	0.0044		0.0054		0.0196
90-day all-cause mortality
Tertiles
<20.5	1.0(ref)		1.0(ref)		1.0(ref)
≥20.5, <25.0	1.21 (0.90, 1.64)	0.2102	1.16 (0.86, 1.57)	0.3421	1.15 (0.85, 1.56)	0.3719
≥25.0	1.71 (1.29, 2.26)	0.0002	1.67 (1.26, 2.22)	0.0004	1.60 (1.19, 2.15)	0.0020
P trend	0.0001		0.0002		0.0013
365-day all-cause mortality
Tertiles
<20.5	1.0(ref)		1.0(ref)		1.0(ref)
≥20.5, <25.0	1.14 (0.87, 1.50)	0.3539	1.08 (0.82, 1.42)	0.5774	1.08 (0.81, 1.42)	0.6105
≥25.0	1.63 (1.26, 2.11)	0.0002	1.60 (1.24, 2.07)	0.0003	1.50 (1.15, 1.97)	0.0030
P trend	<0.0001		0.0001		0.0017

Notes: Models were derived from Cox proportional hazards regression models. Non-adjusted model adjust for: none. Adjust I model adjust for: age, ethnicity and gender. Adjust II model adjust for: age, gender, ethnicity, sodium, chloride, congestive heart failure, coronary artery disease, atrial fibrillation, renal disease, liver disease, chronic obstructive pulmonary disease.

Abbreviations: HR, hazard ratio; CI, confidence interval.

Table 3 Subgroup Analysis of the Associations Between the Neutrophil Percentage-to-Albumin Ratios and 30-Day All-Cause Mortality

	No. of Patients	Neutrophil Percentage-to-Albumin Ratios			P for Interaction
		<20.5	≥20.5, <25.0	≥25.0
Age, years					0.2351
<69.2	470	1.0(ref)	1.71 (0.98, 2.97)	2.15 (1.28, 3.60)
≥69.2	470	1.0(ref)	0.84 (0.56, 1.27)	1.19 (0.81, 1.76)
Gender					0.8199
Female	424	1.0(ref)	1.26 (0.80, 2.00)	1.69 (1.10, 2.61)
Male	516	1.0(ref)	1.09 (0.69, 1.74)	1.39 (0.89, 2.17)
Ethnicity					0.1416
White	669	1.0(ref)	1.12 (0.76, 1.65)	1.47 (1.02, 2.13)
Black	82	1.0(ref)	4.60 (0.89, 23.72)	4.58 (0.95, 22.07)
Other	189	1.0(ref)	0.90 (0.47, 1.72)	1.34 (0.72, 2.51)
SBP, mmHg					0.5523
<127	469	1.0(ref)	1.13 (0.67, 1.88)	1.63 (1.04, 2.56)
≥127	470	1.0(ref)	1.21 (0.79, 1.86)	1.47 (0.94, 2.32)
DBP, mmHg					0.1894
<63	469	1.0(ref)	0.78 (0.48, 1.27)	1.30 (0.85, 1.98)
≥63	470	1.0(ref)	1.66 (1.05, 2.61)	1.85 (1.17, 2.93)
MBP, mmHg					0.3216
<82	469	1.0(ref)	0.89 (0.54, 1.47)	1.40 (0.91, 2.15)
≥82	470	1.0(ref)	1.45 (0.93, 2.24)	1.72 (1.09, 2.70)
Respiratory rate, beats/minute					0.6852
<18	469	1.0(ref)	1.34 (0.84, 2.12)	1.74 (1.08, 2.80)
≥18	469	1.0(ref)	1.00 (0.63, 1.59)	1.30 (0.86, 1.96)
Temperature, °C					0.2201
<36.9	466	1.0(ref)	1.57 (0.98, 2.51)	1.69 (1.08, 2.66)
≥36.9	467	1.0(ref)	0.89 (0.56, 1.40)	1.45 (0.94, 2.21)
SPO2, %					0.3479
<98	469	1.0(ref)	1.12 (0.66, 1.88)	1.67 (1.04, 2.70)
≥98	470	1.0(ref)	1.14 (0.75, 1.74)	1.38 (0.92, 2.07)
Sodium, mmol/l					0.6897
<140	423	1.0(ref)	1.42 (0.85, 2.38)	1.83 (1.11, 3.01)
≥140	514	1.0(ref)	1.02 (0.66, 1.57)	1.37 (0.92, 2.05)
Potassium, mmol/l					0.4276
<4.3	427	1.0(ref)	1.24 (0.76, 2.02)	2.09 (1.30, 3.37)
≥4.3	510	1.0(ref)	1.13 (0.73, 1.77)	1.26 (0.84, 1.90)
Chloride, mmol/l					0.5696
<107	439	1.0(ref)	1.05 (0.65, 1.69)	1.84 (1.17, 2.89)
≥107	498	1.0(ref)	1.29 (0.81, 2.04)	1.39 (0.90, 2.15)
WBC, 10^9 /l					0.0215
<13.1	462	1.0(ref)	1.57 (0.94, 2.64)	2.42 (1.47, 3.98)
≥13.1	475	1.0(ref)	0.85 (0.55, 1.30)	1.00 (0.67, 1.48)
Platelet, 10^9 /l					0.4410
<239	463	1.0(ref)	1.09 (0.68, 1.75)	1.59 (1.04, 2.43)
≥239	474	1.0(ref)	1.28 (0.80, 2.02)	1.52 (0.96, 2.40)
Hematocrit, %					0.3502
<37.4	463	1.0(ref)	0.98 (0.60, 1.62)	1.37 (0.89, 2.11)
≥37.4	474	1.0(ref)	1.35 (0.87, 2.10)	1.74 (1.09, 2.77)
Hemoglobin, g/dl					0.9761
<12.6	454	1.0(ref)	1.20 (0.73, 1.98)	1.49 (0.96, 2.32)
≥12.6	483	1.0(ref)	1.16 (0.75, 1.80)	1.61 (1.02, 2.55)
Creatinine, mEq/l					0.0650
<1.1	446	1.0(ref)	1.46 (0.87, 2.44)	2.17 (1.29, 3.65)
≥1.1	491	1.0(ref)	1.00 (0.65, 1.55)	1.15 (0.78, 1.69)
BUN, mg/dl					0.1011
<24	440	1.0(ref)	1.59 (0.98, 2.59)	1.90 (1.09, 3.32)
≥24	497	1.0(ref)	0.87 (0.56, 1.37)	1.14 (0.78, 1.68)
Anion gap, mmol/l					0.5589
<16	362	1.0(ref)	1.02 (0.53, 1.94)	1.35 (0.74, 2.47)
≥16	574	1.0(ref)	1.23 (0.84, 1.81)	1.64 (1.14, 2.36)
Bicarbonate, mg/dl					0.5392
<25	398	1.0(ref)	1.00 (0.62, 1.63)	1.17 (0.74, 1.84)
≥25	538	1.0(ref)	1.26 (0.80, 1.98)	1.83 (1.19, 2.82)
Glucose, mg/dl					0.1462
<164	467	1.0(ref)	0.94 (0.53, 1.65)	1.80 (1.10, 2.95)
≥164	470	1.0(ref)	1.16 (0.76, 1.75)	1.25 (0.84, 1.87)
PT, second					0.5228
<14	456	1.0(ref)	1.06 (0.65, 1.72)	1.24 (0.72, 2.15)
≥14	471	1.0(ref)	1.31 (0.83, 2.05)	1.49 (1.00, 2.22)
APTT, second					0.5421
<30	461	1.0(ref)	0.90 (0.56, 1.44)	1.09 (0.64, 1.85)
≥30	464	1.0(ref)	1.62 (1.01, 2.57)	1.77 (1.17, 2.68)
INR					0.2899
<1.3	446	1.0(ref)	0.89 (0.55, 1.44)	1.11 (0.64, 1.91)
≥1.3	481	1.0(ref)	1.51 (0.96, 2.38)	1.65 (1.10, 2.50)
CHF					0.1365
No	834	1.0(ref)	1.27 (0.91, 1.79)	1.73 (1.25, 2.41)
Yes	106	1.0(ref)	0.38 (0.10, 1.45)	0.71 (0.29, 1.77)
AFIB					0.9222
No	658	1.0(ref)	1.22 (0.82, 1.82)	1.54 (1.05, 2.26)
Yes	282	1.0(ref)	1.07 (0.60, 1.89)	1.49 (0.88, 2.51)
CAD					0.0806
No	777	1.0(ref)	1.37 (0.96, 1.95)	1.58 (1.12, 2.22)
Yes	163	1.0(ref)	0.53 (0.23, 1.23)	1.35 (0.66, 2.76)
Malignancy					0.5813
No	802	1.0(ref)	1.24 (0.87, 1.76)	1.54 (1.10, 2.17)
Yes	138	1.0(ref)	0.78 (0.31, 1.99)	1.56 (0.74, 3.30)
Liver disease					0.0806
No	895	1.0(ref)	1.10 (0.78, 1.54)	1.52 (1.10, 2.09)
Yes	45	1.0(ref)	4.28 (1.10, 16.67)	1.81 (0.49, 6.70)
Renal disease					0.1191
No	814	1.0(ref)	1.30 (0.91, 1.85)	1.69 (1.20, 2.39)
Yes	126	1.0(ref)	0.55 (0.23, 1.31)	0.74 (0.37, 1.50)
Respiratory failure					0.7417
No	576	1.0(ref)	1.07 (0.71, 1.61)	1.46 (0.95, 2.25)
Yes	364	1.0(ref)	1.30 (0.74, 2.27)	1.42 (0.86, 2.35)
Pneumonia					0.0696
No	658	1.0(ref)	1.42 (0.96, 2.09)	1.91 (1.31, 2.80)
Yes	282	1.0(ref)	0.68 (0.36, 1.27)	0.93 (0.55, 1.59)
COPD					0.3686
No	932	1.0(ref)	1.18 (0.85, 1.65)	1.55 (1.13, 2.12)
Yes	8	1.0(ref)	0.37 (0.02, 5.97)	0.77 (0.07, 8.58)
SAPSII					0.3904
<38	437	1.0(ref)	1.63 (0.91, 2.91)	1.32 (0.65, 2.71)
≥38	503	1.0(ref)	0.85 (0.57, 1.26)	0.99 (0.70, 1.42)
APSIII					0.7695
<43	459	1.0(ref)	1.39 (0.81, 2.37)	1.80 (1.01, 3.24)
≥43	481	1.0(ref)	1.08 (0.71, 1.63)	1.09 (0.75, 1.58)

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure; WBC, white blood cell; BUN, blood urea nitrogen; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio; CHF, congestive heart failure; AFIB, atrial fibrillation; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; SAPSII, simplified acute physiology score.