BACKGROUND:At present, there is no epidemiological study available to confirm the efficacy of neutrophil to high-density lipoprotein cholesterol ratio (NHR) in assessing the prognosis of the asthma population. This study aims to investigate the value of NHR in assessing the prognosis of asthma patients by utilizing data from National Health and Nutrition Examination Survey (NHANES) and constructing the predictive models. METHODS:This study used Cox regression models, cumulative risk curves, and survival 3D interaction plots to check how NHR related to the outcomes for asthma patients. This study also used the least absolute shrinkage and selection operator (LASSO) regression screening to construct key variables for the prediction model, followed by the use of time-dependent receiver operating characteristic (ROC) curves and Shapley additive explanations (SHAP) models to evaluate the performance and practical value of the prediction model. RESULTS:The Cox regression models (HR: 1.12, 95% CI: 1.03-1.22), cumulative risk curves, and survival 3D interaction plots all confirmed that, after accounting for other factors, a higher NHR is linked to a lower survival rate and a higher risk of death for asthma patients. According to the LASSO regression and SHAP model, the five most important significant indicators predicting mortality in individuals with asthma were age, cholesterol, NHR, cardiovascular disease (CVD), and hypertension. The combination of these significant indicators produced superior performance when predicting the 1-year (AUC: 0.874), 5-year (AUC: 0.853), and 9-year (AUC: 0.877) all-cause mortality of asthma populations. CONCLUSIONS:In this nationally representative cohort of participants with asthma, elevated NHR was independently associated with higher all-cause mortality risk. NHR may serve as a readily available marker reflecting systemic inflammatory-metabolic status, but its clinical utility for asthma risk stratification requires further validation in independent cohorts.
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