Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis
Abstract Background The impact of concurrent sepsis on the prognosis in patients with non-traumatic hemorrhagic brain injury (HBI) remains unclear, and the appropriate hemoglobin (HGB) level in HBI patients with sepsis has not been investigated. This study aimed to investigate the impact of sepsis i...
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BMC
2025-03-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-025-02417-6 |
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| author | Xinyuan Ding Guolong Cai Shangzhong Chen Chengcheng Zheng Yanfei Shen |
| author_facet | Xinyuan Ding Guolong Cai Shangzhong Chen Chengcheng Zheng Yanfei Shen |
| author_sort | Xinyuan Ding |
| collection | DOAJ |
| description | Abstract Background The impact of concurrent sepsis on the prognosis in patients with non-traumatic hemorrhagic brain injury (HBI) remains unclear, and the appropriate hemoglobin (HGB) level in HBI patients with sepsis has not been investigated. This study aimed to investigate the impact of sepsis in HBI and the prognosis of patients with different HGB trajectories with/without sepsis. Methods The association between sepsis and prognosis (including neurologic outcome and 28-day mortality) in patients with non-trauma HBI was investigated, and multivariate logistic model, propensity score matching (PSM), and inverse-probability-weighted regression adjustment (IPWRA) were used to reach a causal relationship. Group-based trajectory analysis was adopted to explore the associations between HGB trajectories and outcomes. Results A total of 3,040 patients were included. Compared with the HBI-without-sepsis group, the HBI-with-sepsis group had higher 28-day mortality and worse neurological outcomes. After adjusting for confounders, the association between sepsis and mortality remains significant in multivariate logistic model (OR 2.31, 95%CI 1.77–3.01), PSM analysis (212/942 vs. 130/942, p < 0.001) and IPWRA model (ATE 0.073, 95%CI 0.04–0.09). Based on 72-h HGB data, four HGB-trajectories were identified. In HBI-without-sepsis cohort, OR for mortality decreased from HGB-traj2 (OR: 0.56, 95% CI 0.33—0.96) to HGB-traj4 (0.26, 95% CI 0.11—0.59), referred to HGB-traj1. But this decreasing trend became non-significant in HBI-with-sepsis cohort. Sensitivity analyses showed similar results. Conclusion In HBI, concurrent sepsis was associated with higher mortality rate. Furthermore, there was an inverse gradient relationship between HGB level and mortality in HBI patients without sepsis, while this association became non-significant in those with sepsis. |
| format | Article |
| id | doaj-art-e27ba800f5e34b92b0c1e13bcc5965a3 |
| institution | DOAJ |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-e27ba800f5e34b92b0c1e13bcc5965a32025-08-20T03:05:52ZengBMCEuropean Journal of Medical Research2047-783X2025-03-0130111010.1186/s40001-025-02417-6Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysisXinyuan Ding0Guolong Cai1Shangzhong Chen2Chengcheng Zheng3Yanfei Shen4The Second Clinical Medical College of Zhejiang, Chinese Medical UniversityDepartment of Intensive Care, Zhejiang HospitalDepartment of Intensive Care, Zhejiang HospitalThe Second Clinical Medical College of Zhejiang, Chinese Medical UniversityDepartment of Intensive Care, Zhejiang HospitalAbstract Background The impact of concurrent sepsis on the prognosis in patients with non-traumatic hemorrhagic brain injury (HBI) remains unclear, and the appropriate hemoglobin (HGB) level in HBI patients with sepsis has not been investigated. This study aimed to investigate the impact of sepsis in HBI and the prognosis of patients with different HGB trajectories with/without sepsis. Methods The association between sepsis and prognosis (including neurologic outcome and 28-day mortality) in patients with non-trauma HBI was investigated, and multivariate logistic model, propensity score matching (PSM), and inverse-probability-weighted regression adjustment (IPWRA) were used to reach a causal relationship. Group-based trajectory analysis was adopted to explore the associations between HGB trajectories and outcomes. Results A total of 3,040 patients were included. Compared with the HBI-without-sepsis group, the HBI-with-sepsis group had higher 28-day mortality and worse neurological outcomes. After adjusting for confounders, the association between sepsis and mortality remains significant in multivariate logistic model (OR 2.31, 95%CI 1.77–3.01), PSM analysis (212/942 vs. 130/942, p < 0.001) and IPWRA model (ATE 0.073, 95%CI 0.04–0.09). Based on 72-h HGB data, four HGB-trajectories were identified. In HBI-without-sepsis cohort, OR for mortality decreased from HGB-traj2 (OR: 0.56, 95% CI 0.33—0.96) to HGB-traj4 (0.26, 95% CI 0.11—0.59), referred to HGB-traj1. But this decreasing trend became non-significant in HBI-with-sepsis cohort. Sensitivity analyses showed similar results. Conclusion In HBI, concurrent sepsis was associated with higher mortality rate. Furthermore, there was an inverse gradient relationship between HGB level and mortality in HBI patients without sepsis, while this association became non-significant in those with sepsis.https://doi.org/10.1186/s40001-025-02417-6MortalityHemoglobinHemorrhagic brain injurySepsis |
| spellingShingle | Xinyuan Ding Guolong Cai Shangzhong Chen Chengcheng Zheng Yanfei Shen Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis European Journal of Medical Research Mortality Hemoglobin Hemorrhagic brain injury Sepsis |
| title | Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis |
| title_full | Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis |
| title_fullStr | Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis |
| title_full_unstemmed | Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis |
| title_short | Associations between sepsis occurrence, hemoglobin level and mortality in patients with non-trauma hemorrhagic brain injuries: trajectory-based analysis |
| title_sort | associations between sepsis occurrence hemoglobin level and mortality in patients with non trauma hemorrhagic brain injuries trajectory based analysis |
| topic | Mortality Hemoglobin Hemorrhagic brain injury Sepsis |
| url | https://doi.org/10.1186/s40001-025-02417-6 |
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