{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:05:14Z","timestamp":1789362314200,"version":"build-2803163510"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute-on-chronic liver failure (ACLF) carries high short-term mortality, and easily available prognostic biomarkers are urgently needed. The neutrophil percentage-to-albumin ratio (NPAR) integrates inflammatory and nutritional status, but its prognostic value in liver failure remains unclear. This study aimed to investigate the association between NPAR and 90-day mortality in patients with liver failure, hypothesizing that elevated NPAR would be associated with worse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 104 adult patients with liver failure (89.4% ACLF) admitted from January 2022 to December 2024. NPAR was calculated as neutrophil percentage divided by albumin concentration. The primary outcome was 90-day mortality. We used log-transformed NPAR in regression analyses to improve model stability. Multivariable logistic regression was performed with MELD score as the sole covariate in a parsimonious two-predictor model, with bootstrap validation (1,000 iterations). Formal tests for interaction were conducted to assess potential effect modification by sex, age (&amp;lt;60 vs. \u226560 years), and ascites status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 104 patients, 29 (27.9%) died within 90 days. The non-survival group had significantly higher NPAR levels [median 2.51 (IQR: 2.17\u20132.82) vs. 1.88 (1.61\u20132.29),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001]. In univariate analysis, log-transformed NPAR was associated with mortality (OR: 2.67 per 1-unit increase in ln-NPAR, 95% CI: 1.04\u20136.86,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.041). After adjustment for MELD score, the association was attenuated and no longer statistically significant (adjusted OR: 1.66, 95% CI: 0.40\u20136.82,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.484). Bootstrap validation confirmed the instability of the adjusted estimate (median OR: 1.64, 95% CI: 0.45\u20139.73). Tests for interaction showed no significant effect modification by sex (\n                      <jats:italic>P<\/jats:italic>\n                      -interaction\u2009=\u20090.393), age (\n                      <jats:italic>P<\/jats:italic>\n                      -interaction\u2009=\u20090.419), or ascites status (\n                      <jats:italic>P<\/jats:italic>\n                      -interaction\u2009=\u20090.799).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After adjustment for MELD score, no statistically significant independent association was demonstrated between ln-NPAR and 90-day mortality (adjusted OR: 1.66, 95% CI: 0.40\u20136.82). Whether NPAR provides incremental prognostic information beyond established severity scores remains to be determined in larger studies. These findings primarily apply to a predominantly ACLF population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1858263","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:39:04Z","timestamp":1789360744000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of NPAR with 90-day mortality in predominantly acute-on-chronic liver failure"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiahua","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maohua","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1097\/CM9.0000000000000298","article-title":"Predictive value of the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver 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