Abstract
BackgroundPeripheral arterial disease is a common vascular condition characterized by the narrowing of peripheral arteries, leading to reduced blood flow and increased risk of cardiovascular events such as myocardial infarction, stroke, and limb amputation. Despite its impact, peripheral arterial disease remains underdiagnosed, making early identification crucial for improving outcomes. The neutrophil percentage-to-albumin ratio, reflecting systemic inflammation and nutritional status, has been proposed as a potential biomarker for assessing peripheral arterial disease risk.MethodsThis study used data from the National Health and Nutrition Examination Survey from 1999 to 2004, including 2864 participants after excluding those with missing data on peripheral arterial disease status, neutrophil percentage-to-albumin ratio, and covariates. Peripheral arterial disease was diagnosed using the ankle-brachial index, with an ankle-brachial index value less than 0.90 indicating peripheral arterial disease. Neutrophil percentage-to-albumin ratio was calculated as the percentage of neutrophils in total white blood cells divided by serum albumin levels. Logistic regression models were used to examine the association between neutrophil percentage-to-albumin ratio and peripheral arterial disease, adjusting for potential confounders, including age, sex, race, educational level, body mass index, hypertension, hyperlipidemia, diabetes, and smoking. A nonrestricted cubic spline analysis was used to assess the nonlinear relationship between neutrophil percentage-to-albumin ratio and peripheral arterial disease.ResultsElevated neutrophil percentage-to-albumin ratio was significantly associated with an increased peripheral arterial disease risk. In the unadjusted model, the highest neutrophil percentage-to-albumin ratio quartile (Q4) had an odds ratio of 2.67 (95% confidence interval, 1.78-4.01; P < 0.001). This association remained significant after adjusting for age, sex, and other confounders, with an odds ratio of 1.86 (95% confidence interval, 1.21-2.85; P = 0.004) in the fully adjusted model. Cubic spline analysis revealed a threshold at a neutrophil percentage-to-albumin ratio of 13.71, above which peripheral arterial disease risk increased significantly. Subgroup analyses indicated stronger associations in individuals with hypertension, hyperlipidemia, and diabetes.ConclusionElevated neutrophil percentage-to-albumin ratio is associated with an increased peripheral arterial disease risk, with a threshold effect at a neutrophil percentage-to-albumin ratio of 13.71. Neutrophil percentage-to-albumin ratio may serve as a valuable, cost-effective biomarker for early peripheral arterial disease detection and risk stratification, particularly in high-risk populations.