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Its prognostic significance for mortality in patients with hyperuricemia (HUA) or gout remains incompletely understood, and whether this association differs between asymptomatic HUA and gout has not been examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We utilized data from the National Health and Nutrition Examination Survey (NHANES, 1999\u20132018). After applying exclusion criteria, 4,344 adults were identified, comprising 3,659 with asymptomatic hyperuricemia and 685 with gout (56.8% male; median age 52 years). The neutrophil percentage-to-albumin ratio (NPAR) was calculated for each participant. All analyses were stratified by clinical subgroup (asymptomatic hyperuricemia vs. gout). Associations between NPAR and all-cause and cardiovascular mortality were evaluated using Kaplan\u2013Meier analysis, weighted multivariable Cox proportional hazards regression, and restricted cubic spline (RCS) models. To account for competing risks from non-cardiovascular death, Fine\u2013Gray subdistribution hazard models were fitted, and cumulative incidence functions were estimated by the Aalen\u2013Johansen method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the asymptomatic HUA subgroup, participants in the highest NPAR quartile (Q4) exhibited significantly elevated risks of all-cause mortality (adjusted HR\u2009=\u20092.08, 95% CI: 1.56\u20132.78,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and cardiovascular mortality (adjusted HR\u2009=\u20092.24, 95% CI: 1.41\u20133.56,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001) after full adjustment, compared with the lowest quartile (Q1). In the gout subgroup, the corresponding HR was 2.14 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028) for all-cause mortality; for cardiovascular mortality, the quartile-based HR was 3.51 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.060), while RCS analysis showed a peak HR of 4.95 at the highest NPAR values. NPAR demonstrated strong predictive accuracy in the full cohort, with an AUC of 0.875 for both all-cause and cardiovascular mortality (Model 4, 10-year). In the competing risks analysis, the association between NPAR and cardiovascular mortality remained significant after accounting for non-cardiovascular death as a competing event, with Q4 maintaining an elevated risk across all adjustment levels (fully adjusted sHR\u2009=\u20091.899, 95% CI: 1.366\u20132.640,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; P for trend\u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NPAR is a robust independent predictor of all-cause and cardiovascular mortality in patients with asymptomatic HUA. The association was attenuated in the gout subgroup, likely due to the smaller sample size and limited cardiovascular events, likely reflecting the smaller sample size and limited cardiovascular events. NPAR may serve as a practical clinical biomarker for risk stratification in HUA and gout populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-06251-4","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T02:25:51Z","timestamp":1784255151000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of the neutrophil percentage-to-albumin ratio for mortality in patients with hyperuricemia and gout"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5420-0423","authenticated-orcid":false,"given":"Xia-Ying","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5531-7618","authenticated-orcid":false,"given":"Da-Hai","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4548-7365","authenticated-orcid":false,"given":"Qing","family":"Ou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5615-9331","authenticated-orcid":false,"given":"Yu-Cheng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9679-3001","authenticated-orcid":false,"given":"Hong-Yun","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Sha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"6251_CR1","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1016\/S0140-6736(21)00569-9","volume":"397","author":"N Dalbeth","year":"2021","unstructured":"Dalbeth N, Gosling AL, Gaffo A, Abhishek A, Gout. 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