Investigating Novel Inflammatory Indices and Their Links to Mortality, Cancer, and Cardiovascular Disease: A 10-Year Cohort Study Publisher



Ghasemzadeh Rahbardar M ; Saffar H ; Shabani N ; Esmaily H ; Najib M ; Moghadasian M ; Mousavifard SA ; Moohebati M ; Soflaei SS ; Ghayourmobarhan M
Source: Health Science Reports Published:2026

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. © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC.