ArticleJournal of inflammation research2026
Sex Modifies the Association Between Neutrophil Percentage-to-Albumin Ratio and Stroke-Associated Pneumonia in Acute Ischemic Stroke.
Article in Journal of inflammation research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Stroke-associated pneumonia (SAP) is a common and serious complication in patients with acute ischemic stroke (AIS), leading to prolonged hospitalization and poor prognosis. The neutrophil percentage-to-albumin ratio (NPAR), a novel inflammatory biomarker, has been linked to stroke-associated infections; however, no prior study has characterized the dose-response relationship between NPAR and SAP or explored potential sex-based effect modification. Methods: This retrospective cohort study included 1008 patients with AIS. NPAR was calculated as neutrophil percentage divided by serum albumin level (g/L) at admission. SAP was defined as pneumonia occurring within 7 days of stroke onset. Multivariable logistic regression models were constructed to evaluate the association between NPAR and SAP, with NPAR analyzed both as a continuous variable (per 0.1-unit increase) and as tertiles. Restricted cubic spline (RCS) analysis was performed to assess the dose-response relationship. Subgroup analyses with interaction tests were conducted to explore potential effect modification, including by sex. Results: Among 1008 AIS patients (mean age 62.18 years; 68.25% male), 90 (8.93%) developed SAP. After full adjustment, each 0.1-unit increase in NPAR was independently associated with SAP (OR = 1.22; 95% CI: 1.13-1.32; Conclusion: Higher NPAR is independently and linearly associated with an increased risk of SAP in AIS patients, with a significant dose-response relationship. This association is significantly stronger in males than in females. NPAR may serve as a readily accessible and cost-effective candidate biomarker for early risk stratification of SAP, particularly in male AIS patients, pending external validation in prospective, multi-center studies.
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