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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Intestinal Bacterial Overgrowth in Severe Traumatic Brain Injury Is Associated with Late In-Hospital Mortality

  • Oleksandr Oliynyk1
  • Wojciech Barg2
  • Oleksandr Yashan3
  • Konstiantyn Krenov4
  • Yury Kovalchuk1
  • Svitlana Yaroslavska1
  • Marta Rorat5
5 affiliations
  1. 1Department of Anesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, Ukraine
  2. 2Department of Health Promotion, Faculty of Physical Culture Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
  3. 3Department of Otolaryngology and Neurosurgery, Ternopil National Medical University, 46000 Ternopil, Ukraine
  4. 4Department of Surgery with a Course in the Basics of Dentistry, Faculty of Postgraduate Education, Vinnytsia National Pirogov Memorial Medical University, 29000 Khmelnytskyi, Ukraine
  5. 5Department of Social Sciences and Infectious Diseases, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland
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Abstract

Background: Severe traumatic brain injury (TBI) is associated with high mortality. There is increasing evidence suggesting that intestinal dysbiosis may influence clinical outcomes; however, its prognostic significance in patients with severe TBI remains poorly defined. Methods: This retrospective cohort study included 235 patients with severe TBI (Glasgow Coma Scale [GCS] score ≤ 8) admitted to the intensive care units of three participating hospitals between September 2023 and December 2024. Quantitative microbiological analysis of jejunal aspirates was performed at admission and repeated on days 12–14 of the ICU stay. Small intestinal bacterial overgrowth (SIBO) was defined as a bacterial load of ≥105 colony-forming units per milliliter (CFU/mL). Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: At admission, SIBO was uncommon (3.8%) but increased to 27.9% among patients who underwent repeated assessment. Within the day-14 landmark cohort (n = 179), post-day-14 mortality was higher in patients with SIBO than in those without (34.0% vs. 23.3%). In multivariable logistic regression analysis, SIBO was independently associated with post-day-14 in-hospital mortality after adjustment for age, body mass index, GCS score, PaO2/FiO2 ratio, and blood glucose (OR 2.83, 95% CI 1.06–7.58; p = 0.039). The ROC model demonstrated good discriminative performance, with an apparent area under the curve (AUC) of 0.846 and an optimism-corrected AUC of 0.823 after bootstrap validation. Conclusions: In patients with severe TBI who survived and remained hospitalized through the day-14 landmark, SIBO detected at days 12–14 was independently associated with increased subsequent in-hospital mortality. However, its incremental contribution to discrimination beyond established clinical predictors was modest. Therefore, late SIBO should be interpreted primarily as a dynamic marker associated with prolonged critical illness and adverse outcome rather than as a demonstrated cause of mortality. Prospective validation is required.

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Cite

BibTeXRIS
BibTeX
@article{oliynyk2026intestinal,
  title = {{Intestinal Bacterial Overgrowth in Severe Traumatic Brain Injury Is Associated with Late In-Hospital Mortality}},
  author = {Oleksandr Oliynyk and Wojciech Barg and Oleksandr Yashan and Konstiantyn Krenov and Yury Kovalchuk and Svitlana Yaroslavska and Marta Rorat},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207896},
  url = {https://www.mdpi.com/2077-0383/15/20/7896},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Intestinal Bacterial Overgrowth in Severe Traumatic Brain Injury Is Associated with Late In-Hospital Mortality
AU  - Oleksandr Oliynyk
AU  - Wojciech Barg
AU  - Oleksandr Yashan
AU  - Konstiantyn Krenov
AU  - Yury Kovalchuk
AU  - Svitlana Yaroslavska
AU  - Marta Rorat
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207896
UR  - https://www.mdpi.com/2077-0383/15/20/7896
AB  - Background: Severe traumatic brain injury (TBI) is associated with high mortality. There is increasing evidence suggesting that intestinal dysbiosis may influence clinical outcomes; however, its prognostic significance in patients with severe TBI remains poorly defined. Methods: This retrospective cohort study included 235 patients with severe TBI (Glasgow Coma Scale [GCS] score ≤ 8) admitted to the intensive care units of three participating hospitals between September 2023 and December 2024. Quantitative microbiological analysis of jejunal aspirates was performed at admission and repeated on days 12–14 of the ICU stay. Small intestinal bacterial overgrowth (SIBO) was defined as a bacterial load of ≥105 colony-forming units per milliliter (CFU/mL). Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: At admission, SIBO was uncommon (3.8%) but increased to 27.9% among patients who underwent repeated assessment. Within the day-14 landmark cohort (n = 179), post-day-14 mortality was higher in patients with SIBO than in those without (34.0% vs. 23.3%). In multivariable logistic regression analysis, SIBO was independently associated with post-day-14 in-hospital mortality after adjustment for age, body mass index, GCS score, PaO2/FiO2 ratio, and blood glucose (OR 2.83, 95% CI 1.06–7.58; p = 0.039). The ROC model demonstrated good discriminative performance, with an apparent area under the curve (AUC) of 0.846 and an optimism-corrected AUC of 0.823 after bootstrap validation. Conclusions: In patients with severe TBI who survived and remained hospitalized through the day-14 landmark, SIBO detected at days 12–14 was independently associated with increased subsequent in-hospital mortality. However, its incremental contribution to discrimination beyond established clinical predictors was modest. Therefore, late SIBO should be interpreted primarily as a dynamic marker associated with prolonged critical illness and adverse outcome rather than as a demonstrated cause of mortality. Prospective validation is required.
SN  - 2077-0383
ER  -