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.