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Войти в исследования Frontiers in nutrition · 2026
Association of delayed enteral nutrition with hospital-acquired pneumonia and 30-day mortality following craniotomy for severe traumatic brain injury: a retrospective cohort study.
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Kang Zhiqiang, Zhang Guodong, Guo Wenjing, Liu Meng, Zhang Dapeng, Shang Fei, Wang Yang
Аннотация
BACKGROUND: Hospital-acquired pneumonia (HAP) is a serious complication after craniotomy for severe traumatic brain injury (TBI), but evidence on modifiable factors, especially delayed enteral nutrition, remains limited.
OBJECTIVE: To evaluate factors associated with HAP after severe TBI surgery, focusing on enteral nutrition timing and the association between HAP and 30-day mortality.
METHODS: This retrospective cohort study included 600 adult patients undergoing craniotomy for severe TBI who survived >48 h. HAP was diagnosed according to CDC/NHSN criteria. Multivariable logistic regression identified factors associated with HAP, and a fully adjusted model assessed the HAP-mortality association. Model performance was assessed by the AUC and Hosmer-Lemeshow test. Sensitivity analyses included forced inclusion of tracheostomy and comparison of the primary model (pre-HAP ventilation duration) with the total ventilation model. A 48-h landmark analysis was also performed. The primary outcome was postoperative HAP; secondary outcomes were ICU stay and 30-day mortality.
RESULTS: Postoperative HAP incidence was 11.5%. After adjustment, delayed enteral nutrition (≥48 h) was independently associated with HAP (OR = 4.46, 95% CI: 2.52-8.19, p < 0.001). Other associated factors included age, admission GCS, mechanical ventilation duration, and serum albumin. The model showed good discrimination (AUC = 0.795) and calibration (Hosmer-Lemeshow p = 0.829). In the time-dependent Cox model, HAP was associated with higher 30-day mortality (HR = 4.31, 95% CI: 1.52-12.25, p = 0.006). The primary model and total ventilation model yielded nearly identical results. In the landmark analysis, mechanical ventilation at 48 h was associated with subsequent HAP (OR = 2.19, 95% CI: 1.02-5.30, p = 0.06). Forced inclusion of tracheostomy did not materially alter core results.
CONCLUSION: In severe TBI patients undergoing craniotomy, delayed enteral nutrition was independently associated with increased HAP risk, and HAP was associated with higher 30-day mortality. These findings highlight the potential importance of early enteral nutrition, but causal inference is limited by the observational design; prospective studies are needed.
OBJECTIVE: To evaluate factors associated with HAP after severe TBI surgery, focusing on enteral nutrition timing and the association between HAP and 30-day mortality.
METHODS: This retrospective cohort study included 600 adult patients undergoing craniotomy for severe TBI who survived >48 h. HAP was diagnosed according to CDC/NHSN criteria. Multivariable logistic regression identified factors associated with HAP, and a fully adjusted model assessed the HAP-mortality association. Model performance was assessed by the AUC and Hosmer-Lemeshow test. Sensitivity analyses included forced inclusion of tracheostomy and comparison of the primary model (pre-HAP ventilation duration) with the total ventilation model. A 48-h landmark analysis was also performed. The primary outcome was postoperative HAP; secondary outcomes were ICU stay and 30-day mortality.
RESULTS: Postoperative HAP incidence was 11.5%. After adjustment, delayed enteral nutrition (≥48 h) was independently associated with HAP (OR = 4.46, 95% CI: 2.52-8.19, p < 0.001). Other associated factors included age, admission GCS, mechanical ventilation duration, and serum albumin. The model showed good discrimination (AUC = 0.795) and calibration (Hosmer-Lemeshow p = 0.829). In the time-dependent Cox model, HAP was associated with higher 30-day mortality (HR = 4.31, 95% CI: 1.52-12.25, p = 0.006). The primary model and total ventilation model yielded nearly identical results. In the landmark analysis, mechanical ventilation at 48 h was associated with subsequent HAP (OR = 2.19, 95% CI: 1.02-5.30, p = 0.06). Forced inclusion of tracheostomy did not materially alter core results.
CONCLUSION: In severe TBI patients undergoing craniotomy, delayed enteral nutrition was independently associated with increased HAP risk, and HAP was associated with higher 30-day mortality. These findings highlight the potential importance of early enteral nutrition, but causal inference is limited by the observational design; prospective studies are needed.