Association between delirium and neutrophil percentage-to-albumin ratio in patients with cervical spinal cord injury: A single-center, retrospective study

Kosuke Nitta, Gentaro Kumagai, Kanichiro Wada, Yohshiro Nitobe, Kotaro Aburakawa, On Takeda, Kazushige Koyama, Hirotaka Kinoshita, Tetsuya Kushikata, Kazuyoshi Hirota, Yasuyuki Ishibashi

Abstract

Single-center, case-control study.

Introduction

Traumatic spinal cord injury (SCI) can be triggered by even minor trauma in older adults [1], and the prevalence of SCI is increasing as the population ages. A study by DeVivo et al. in the United States reported that the percentage of patients aged ≥60 years increased from 4.6% in 1970 to 20.4% in 2017 [2].

Materials and methods

This case-control study was conducted at a single tertiary emergency center in Japan, using medical records of acute CSCI patients who were admitted to and treated by our orthopedic department between 2010 and 2023. Spinal cord injuries were diagnosed by our orthopedic surgeons.

Results

Of the 147 patients included in the analysis, 15 (10.2%; 11 [11.3%] of whom underwent conservative treatment and 4 [8.0%] of whom underwent surgery) developed delirium after CSCI (Fig 2). In the delirium group, the diagnosis was made at a mean of 2.9 days (range: 2–5 days) post-injury.

Discussion

The present study investigated the incidence of delirium and associated factors in a population of patients with CSCI. In patients with CSCI, the incidence of delirium was 10.2%. Univariate logistic regression analysis identified alcohol use at the time of injury as a significant risk factor for delirium.

Conclusions

In this single-center, case-control study, the incidence of delirium in patients with CSCI was 10.2%. Elevated NPAR was associated with an increased risk of delirium. NPAR may serve as a simple and measurable biomarker for predicting delirium in patients following CSCI.

Citation: Nitta K, Kumagai G, Wada K, Nitobe Y, Aburakawa K, Takeda O, et al. (2026) Association between delirium and neutrophil percentage-to-albumin ratio in patients with cervical spinal cord injury: A single-center, retrospective study. PLoS One 21(1): e0339174. https://doi.org/10.1371/journal.pone.0339174

Editor: Pedro Kallas Curiati, Instituto Sirio-Libanes de Ensino e Pesquisa, BRAZIL

Received: July 7, 2025; Accepted: December 2, 2025; Published: January 27, 2026

Copyright: © 2026 Nitta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data cannot be made publicly available due to ethical restrictions. The dataset contains human participant data with potentially identifying indirect identifiers (including precise age, sex, height, and weight), which could compromise participant privacy and the terms of consent. The minimal data set required to replicate the study’s findings is available upon reasonable request from the Institutional Review Board of Hirosaki University Hospital (contact via [[email protected]]). Access will be granted to qualified researchers who meet the criteria for access to confidential data.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.