Abstract
BACKGROUND: Neutrophil-to-HDL-C ratio (NHR) has recently emerged as a composite biomarker integrating lipid metabolism and inflammatory status. Nevertheless, its potential association with the risk of gout or hyperuricemia remains inadequately explored. The present study aimed to examine the possible link between NHR and both conditions. METHODS: This study included 31,117 eligible adults from the 2007-2018 NHANES database in the United States. Participants were categorized into NHR quartiles, and weighted multivariate logistic regression along with restricted cubic spline (RCS) analyses was performed to assess its association with gout and hyperuricemia risk. Subgroup analyses were performed to assess the robustness and heterogeneity of the association across different subpopulations. All analyses were weighted to guarantee the generalizability of the findings to the national population. RESULTS: A positive correlation was observed between NHR and the risk of both gout and hyperuricemia. As NHR levels increased, the proportion of participants with gout or hyperuricemia rose significantly-specifically, the prevalence of gout was 2.46%, 3.69%, 4.24%, and 5.79% (p < 0.001), and for hyperuricemia, it was 13.63%, 17.38%, 20.65%, and 26.08% (p < 0.001), respectively. Multivariable logistic regression indicated that, in the unadjusted Model 1 analysis, each 1-unit increase in NHR was associated with a 5.1% higher risk of gout (OR = 1.051, 95% CI 1.036-1.069, p < 0.001) and a 5.8% higher risk of hyperuricemia (OR = 1.058, 95% CI 1.051-1.066, p < 0.001). The positive association remained stable and statistically significant after adjusting for potential confounding variables. Further RCS analysis revealed a nonlinear trend in the relationship between NHR and both conditions, with a potential risk threshold of approximately 16, beyond which the risk of disease increased substantially. Additionally, receiver operating characteristic (ROC) analysis showed that the NHR had better discriminatory performance than either HDL-C or NEU alone in predicting hyperuricemia (AUC = 0.682) and gout (AUC = 0.81). CONCLUSION: NHR showed a significant association with the risk of gout and hyperuricemia, demonstrating a nonlinear dose-response pattern. NHR may serve as a promising inflammation-metabolism marker for the early identification of individuals at risk for uric acid-related disorders.