Abstract
Abstract
Background and Aims
Inflammatory indices, including neutrophil‐to‐lymphocyte‐platelet ratio (NLPR), systemic immune‐inflammation index (SII), platelet‐to‐lymphocyte ratio (PLR), and neutrophil‐to‐lymphocyte ratio (NLR) have been proposed as prognostic markers for mortality. This study explored the links between novel inflammatory markers and mortality, including all‐cause death, cancer, and cardiovascular disease (CVD).
Methods
The MASHAD cohort study included adults aged 35–65 years through a stratified cluster sampling method. Demographic, health‐related, and inflammatory indices data were collected at baseline. Participants were followed for 10 years. Cox regression and Kaplan‐Meier survival analyses were employed to examine the associations of inflammatory markers with mortality outcomes.
Results
In unadjusted analyses, NLPR in the highest tertile (≥ 0.035) was associated with increased risks of all‐cause mortality (HR = 1.43; 95% CI: 1.10–1.88;
p
= 0.009) and CVD mortality (HR = 1.73; 95% CI: 1.11–2.69;
p
= 0.020), but these associations were attenuated after adjustment (all‐cause mortality: HR = 1.11; 95% CI: 0.84–1.48;
p
= 0.458). PLR in the mid‐tertile (93.70–123.53) had a protective effect against all‐cause mortality in adjusted models (HR = 0.74; 95% CI: 0.57–0.97;
p
= 0.027). The Kaplan‐Meier survival analysis demonstrated notable variations in survival curves for NLPR with all‐cause (
p
= 0.030), CVD mortality (
p
= 0.023), and PLR with all‐cause mortality (
p
= 0.004). Lower all‐cause mortality was observed in the mid‐tertile of PLR, specifically among men and those without hypertension or CVD, according to subgroup analysis. NLR and SII were not associated with mortality.
Conclusion
PLR and NLPR have potential as prognostic markers for all‐cause mortality, with PLR demonstrating a consistent protective effect at moderate levels. Further research with extended follow‐up periods is necessary to confirm these results and investigate their potential relevance to clinical practice.