Retrospective cohort study.
To investigate the association between neutrophil percentage-to-albumin ratio (NPAR) and pneumonia in patients with SCI.
Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University.
SCI patients admitted to West China Hospital within 24 h of injury were consecutively enrolled. Blood samples were collected on admission. Pneumonia was diagnosed based on chest radiography and clinician records of patient symptoms and laboratory tests. Multivariable logistic regression analysis was performed to determine the relationship between NPAR and pneumonia. Receiver operating characteristic (ROC) curves were generated to assess the predictive value of NPAR.
A total of 264 SCI patients were included, of whom 65 (24.6%) developed pneumonia. NPAR was positively correlated with pneumonia (OR 2.66, 95% CI, 1.06–6.71, p = 0.038). Patients in the upper NPAR tertile (2.35–3.71) had a higher risk of pneumonia than patients in the lower tertile (1.66–2.12) after adjustment for potential confounders (OR 2.55, 95% CI, 1.05–6.19, p = 0.039). The risk of pneumonia increased stepwise across NPAR tertiles (p for trend = 0.031). The optimal cutoff value of NPAR for predicting pneumonia was 2.17 with a sensitivity of 0.82 and a specificity of 0.50. There was a significant interaction between NPAR and neurological level of injury (p for interaction = 0.034), with no significant association between NPAR and pneumonia in patients with cervical SCI.
A higher NPAR was independently associated with higher risk of pneumonia in a dose-dependent manner in patients with non-cervical SCI.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
Weinberg DS, Hedges BZ, Belding JE, Moore TA, Vallier HA. Risk factors for pulmonary complication following fixation of spine fractures. Spine J. 2017;17:1449–56.
Agostinello J, Battistuzzo CR, Batchelor PE. Early clinical predictors of pneumonia in critically ill spinal cord injured individuals: a retrospective cohort study. Spinal Cord. 2019;57:41–8.
Kopp MA, Watzlawick R, Martus P, Failli V, Finkenstaedt FW, Chen Y, et al. Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology. 2017;88:892–900.
Winslow C, Bode RK, Felton D, Chen D, Meyer PR Jr. Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury. Chest. 2002;121:1548–54.
Pan YP, Fang YP, Xu YH, Wang ZX, Shen JL. The diagnostic value of procalcitonin versus other biomarkers in prediction of bloodstream infection. Clin Lab. 2017;63:277–85.
Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, et al. Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study. Am J Med. 2020;133:713–22. e7
Sun T, Shen H, Guo Q, Yang J, Zhai G, Zhang J, et al. Association between neutrophil percentage-to-albumin ratio and all-cause mortality in critically ill patients with coronary artery disease. Biomed Res Int. 2020;2020:8137576.
Wang X, Wang J, Wu S, Ni Q, Chen P. Association between the neutrophil percentage-to-albumin ratio and outcomes in cardiac intensive care unit patients. Int J Gen Med. 2021;14:4933–43.
Gong Y, Li D, Cheng B, Ying B, Wang B. Increased neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with severe sepsis or septic shock. Epidemiol Infect. 2020;148:e87.
Cui H, Ding X, Li W, Chen H, Li H. The neutrophil percentage to albumin ratio as a new predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction. Med Sci Monit. 2019;25:7845–52.
Yu Y, Liu Y, Ling X, Huang R, Wang S, Min J, et al. The neutrophil percentage-to-albumin ratio as a new predictor of all-cause mortality in patients with cardiogenic shock. Biomed Res Int. 2020;2020:7458451.
Wang B, Li D, Cheng B, Ying B, Gong Y. The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in critically ill patients with acute kidney injury. Biomed Res Int. 2020;2020:5687672.
Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, et al. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus. 2017;43:E19.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.
Smith CJ, Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ, et al. Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group. Stroke. 2015;46:2335–40.
Park SY, Freedman ND, Haiman CA, Le Marchand L, Wilkens LR, Setiawan VW. Association of coffee consumption with total and cause-specific mortality among nonwhite populations. Ann Intern Med. 2017;167:228–35.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.
Jogia T, Lübstorf T, Jacobson E, Scriven E, Atresh S, Nguyen QH, et al. Prognostic value of early leukocyte fluctuations for recovery from traumatic spinal cord injury. Clin Transl Med. 2021;11:e272.
David S, Kroner A, Greenhalgh AD, Zarruk JG, López-Vales R. Myeloid cell responses after spinal cord injury. J Neuroimmunol. 2018;321:97–108.
Kanyilmaz S, Hepguler S, Atamaz FC, Gokmen NM, Ardeniz O, Sin A. Phagocytic and oxidative burst activity of neutrophils in patients with spinal cord injury. Arch Phys Med Rehabil. 2013;94:369–74.
Kubota K, Saiwai H, Kumamaru H, Maeda T, Ohkawa Y, Aratani Y, et al. Myeloperoxidase exacerbates secondary injury by generating highly reactive oxygen species and mediating neutrophil recruitment in experimental spinal cord injury. Spine. 2012;37:1363–9.
Brennan, FH, Jogia, T, Gillespie, ER, Blomster, LV, Li, XX, Nowlan, B, et al. Complement receptor C3aR1 controls neutrophil mobilization following spinal cord injury through physiological antagonism of CXCR2. JCI Insight. 2019;4:e98254.
Sun X, Jones ZB, Chen XM, Zhou L, So KF, Ren Y. Multiple organ dysfunction and systemic inflammation after spinal cord injury: a complex relationship. J Neuroinflammation. 2016;13:260.
Lee JL, Oh ES, Lee RW, Finucane TE. Serum albumin and prealbumin in calorically restricted, nondiseased individuals: a systematic review. Am J Med. 2015;128:1023.e1–22.
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enter Nutr. 2019;43:181–93.
Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med. 2018;52:8–12.
Dziedzic T, Pera J, Klimkowicz A, Turaj W, Slowik A, Rog TM, et al. Serum albumin level and nosocomial pneumonia in stroke patients. Eur J Neurol. 2006;13:299–301.
Terson de Paleville DG, McKay WB, Folz RJ, Ovechkin AV. Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Transl Stroke Res. 2011;2:463–73.
Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injury. Respir Care. 2006;51:853–68. discussion 69-70
Failli V, Kopp MA, Gericke C, Martus P, Klingbeil S, Brommer B, et al. Functional neurological recovery after spinal cord injury is impaired in patients with infections. Brain. 2012;135:3238–50. Pt 11
Liebscher T, Niedeggen A, Estel B, Seidl RO. Airway complications in traumatic lower cervical spinal cord injury: A retrospective study. J Spinal Cord Med. 2015;38:607–14.
This work was supported by the National Natural Science Foundation (82102656); China Postdoctoral Science Foundation (2021M692299); PostDoctor Research Project, West China Hospital, Sichuan University (2021HXBH021); Sichuan Provincial Natural Science Foundation of China (2022NSFSC1312).
The authors declare no competing interests.
This study was approved by the Scientific Research Department of West China Hospital (approval no. 2021-1413).
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Wang, C., Yu, X., Wang, T. et al. Association between neutrophil percentage-to-albumin ratio and pneumonia in patients with traumatic spinal cord injury. Spinal Cord 61, 106–110 (2023). https://doi.org/10.1038/s41393-022-00844-4