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Association between neutrophil percentage-to-albumin ratio and pneumonia in patients with traumatic spinal cord injury


Study design

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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Fig. 1: Flowchart of patient selection.
Fig. 2: The multiple spline regression analysis to investigate the relationship between NPAR and pneumonia.
Fig. 3: Comparison of predictive value between NPAR and other parameters in the prediction of pneumonia.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.


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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).

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Authors and Affiliations



CQH and QW conceived and designed the study. CYW, XY, TTW, LYR, LW, and XS acquired the data, which CYW analyzed. CYW, XY, TTW, and MFD aided in data interpretation and wrote the manuscript. All authors were involved in revising the article and approved the final version.

Corresponding author

Correspondence to Chengqi He.

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The authors declare no competing interests.

Ethical approval

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 (2022).

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