Discussion
intracranial hypertension, post-traumatic autoimmune, Sepsis, clearance disorder, consciousness disturbance, traumatic bleeding, anemia, organ dysfunction, dysphagia,, infection, cough, TBI, acute lung injury, AKI, sepsis, kidney injury, post-traumatic sympathetic nervous system, disturbance of consciousness
SEPSIS, HAND INFECTION, NEUROGENIC PULMONARY EDEMA, ANEMIA, INFECTION, SECONDARY, REGRESSION, SEPSIS, COMPLICATIONS
The study subjects in this study were TBI patients admitted to ICU. Based on these patients’ demographic information, laboratory test indicators, and complications, a nomogram for predicting the risk of secondary sepsis in TBI patients was plotted. The results of feature selection showed that AKI, anemia, invasive ventilation, GCS score, lactic acid, and serum calcium level were important predictors of secondary sepsis in TBI patients in the ICU. The AUC of the nomogram model based on the above variables is greater than 0.7 in both training validation cohorts, indicating favorable prediction accuracy.Sepsis is a life-threatening organ dysfunction caused by disordered body responses to infection [Therefore, we took a specific population (i.e., TBI patients) as subjects, whose onset risks were predicted specifically by using up-to-date international consensus as the diagnosis criteria in this study. Besides, we constructed a nomogram model based on stepwise Logistic regression. As a visualized model, a nomogram can quantify the influence of each prediction variable on the results and offer practical explanations [Our results showed that AKI, anemia, invasive ventilation, GCS score, lactic acid, and serum calcium level were significant predictors of secondary sepsis in TBI patients in the ICU. Furthermore, TBI patients with AKI have a higher risk of sepsis. For TBI patients, post-traumatic sympathetic nervous system activation, increased plasma catecholamine level, elevated systolic blood pressure, low blood volume, cytokine cascade reaction, and osmotic therapy of intracranial hypertension will bring a higher risk of kidney injury [The risk of acute lung injury and infection in TBI patients is increased due to post-traumatic autoimmune and lung immune damage, neurogenic pulmonary edema, and impaired lung protective mechanisms following disturbance of consciousness [Lactic acid is a commonly used biological marker for the diagnosis and prognosis of sepsis [Due to fluid dilution caused by intravenous fluid resuscitation and traumatic bleeding (preoperative and perioperative periods), anemia is very common in TBI patients, especially in moderate and severe TBI patients [Moreover, our results show that consciousness disturbance is one of the risk factors for sepsis, which is consistent with our hypothesis. TBI patients face an increased risk of HAP due to changes in mental state, dysphagia, vomiting, cough reflex, and secretion clearance disorder [Furthermore, the blood calcium level is included in many machine learning models for sepsis prediction [With an AUC of greater than 0.7, our prediction model demonstrated favorable prediction efficiency and filled the gap in tools for predicting sepsis in TBI patients admitted to the ICU. Our prediction model enables clinicians to identify the risk of secondary sepsis in TBI patients at an early stage and develop targeted treatment plans according to risk factors, thus reducing the incidence of sepsis and improving the prognosis of patients.However, this study has several limitations. First of all, our model has not been verified in an external cohort, and we will carry out further research in the future. Secondly, due to the limited types of variables in the public database, some variables of interest, such as cerebrospinal fluid examination and brain imaging data, were not included in the study.