Association between neutrophil percentage to albumin ratio and mortality in takotsubo syndrome patients: analysis of the MIMIC-IV database.

BACKGROUND: This study investigates the association between the neutrophil percentage-to-albumin ratio (NPAR) and mortality in takotsubo syndrome (TS) patients. METHODS: We conducted a retrospective cohort study using data from the MIMIC-IV version 3.1 database. Multivariable Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the associations between NPAR and 28-day, 180-day, and 365-day mortality. Predictive performance for 28-day mortality was assessed using receiver operating characteristic (ROC) analysis and seven machine-learning models. RESULTS: A total of 201 patients with TS were included. Higher NPAR was independently associated with increased 28-day mortality (HR 5.494, 95% CI 1.939-12.190, P < 0.001), 180-day mortality (HR 5.141, 95% CI 2.367-11.166, P < 0.001), and 365-day mortality (HR 5.280, 95% CI 2.439-11.429, P < 0.001). RCS analysis showed a significant overall association between NPAR and 28-day mortality (P for overall = 0.041), without significant nonlinearity (P for nonlinear = 0.194). NPAR showed modest predictive ability for 28-day mortality (AUC 0.640). In machine-learning analyses, NPAR was identified as an important prognostic feature, and the random forest model achieved the highest AUC (0.771). CONCLUSIONS: Higher NPAR values are associated with increased mortality rates at 28-day, 180-day, and 365-day intervals in TS patients, suggesting NPAR as a potential predictive marker for TS outcomes.