The Combined Impact of Neutrophil-percentage-to-albumin ratio and Depressive Symptoms on Mortality in US arthritis Patients: Insights from NHANES (2005-2018)

Jinyue Bai ¹ Taihong Lv ² Hanming Yu ³ Zishuo Ji ² Xiu Gu ³ Yun Gao ¹ Li Ma ^2*

• ¹ Aerospace Center Hospital, Beijing, China
• ² Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ³ Fourth Affiliated Hospital of China Medical University, Shenyang, China

The neutrophil-to-albumin ratio (NPAR) reflects inflammation and nutritional status, while depression significantly impacts survival in chronic disease patients. This study examines the independent and combined effects of NPAR and depressive symptoms on all-cause and cardiovascular mortality in arthritis patients.We analyzed a nationally representative sample of people with arthritisaged 40 and older from NHANES (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). NPAR assessed inflammation and nutritional status, while depressive symptoms were measured by PHQ-9.Weighted Cox regression examined the independent and joint associations of NPAR and PHQ-9 with all-cause and cardiovascular disease (CVD) mortality.Results: Our analysis indicated that higher NPAR levels combined with lower depressive symptoms (PHQ-9 <10) significantly increased all-cause and CVD mortality risks in arthritis patients. In this group, the hazard ratio (HR) for all-cause mortality was 2.087, with a similarly elevated CVD mortality risk (HR = 2.614), underscoring NPAR's predictive strength in non-depressed individuals. Among those with higher depressive symptoms, while elevated NPAR was still associated with increased mortality, its impact on CVD mortality was less marked, highlighting the need for further research into the NPAR-depression interaction.This study identifies NPAR as a key predictor of mortality in arthritis patients, particularly those with fewer depressive symptoms. NPAR significantly predicts all-cause and CVD mortality, underscoring its value as an inflammation and nutrition biomarker. Integrating NPAR in clinical practice could enhance individualized risk assessment and intervention for arthritis patients.Contribution to the literature -Inflammation, nutrition and mental health are important factors influencing the risk of death in arthritis.-The potential value of NPAR as a validated biomarker that can be used to stratify mortality risk in patients with arthritis.-There is an urgent need for public health policies to address the development of depressive symptoms in patients with arthritis.