Analysis of risk factors and development of predictive model for malnutrition in patients with traumatic brain injury

ABSTRACT

Malnutrition is a highly prevalent complication in patients with traumatic brain injury (TBI), and it is closely related to the prognosis of patients. Accurate identification of patients at high risk of malnutrition is essential. Therefore, we analyzed the risk factors of malnutrition in patients with TBI and developed a model to predict the risk of malnutrition. A retrospective collection of 345 patients with TBI, and they were divided into malnutrition and comparison groups according to the occurrence of malnutrition. Univariate correlation and multifactor logistic regression analyses were performed to determine patients’ malnutrition risk factors. We used univariate and logistic regression (forward stepwise method) analyses to identify significant predictors associated with malnutrition in patients with TBI and developed a predictive model for malnutrition prediction. The model's discrimination, calibration, and clinical utility were evaluated using the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). A total of 216 patients (62.6%) developed malnutrition. Multifactorial logistic regression analysis showed that pulmonary infection, urinary tract infection, dysphagia, application of NGT, GCS score ≤ 8, and low ADL score were independent risk factors for malnutrition in patients with TBI (P < 0.05). The area under the curve of the model was 0.947. Calibration plots showed good discrimination of model calibration. DCA showed that the column line plot models were all clinically meaningful when nutritional interventions were performed over a considerable range of threshold probabilities (0-0.98). Malnutrition is widespread in patients with TBI, and the nomogram is a good predictor of whether patients develop malnutrition.

KEYWORDS:

• Traumatic brain injury
• malnutrition
• risk factor
• ‌dysphagia
• ‌pulmonary infection
• eating pattern‌
• prediction model
• nomogram

Acknowledgments

The authors are grateful to all members who supported this study and modified the article, especially Nana Xiong and Teng Zhang.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data

Data are available upon reasonable request. Please get in touch with the corresponding author.

Additional information

Notes on contributors

Ang Cai

Ang Cai is a master's candidate studying in the First Affiliated Hospital of Zhengzhou University, majoring in Rehabilitation Medicine and Physical Therapy. His research interests include the nutritional status of patients with traumatic brain injury or stroke.

Yi Li

Yi Li is a research leader in the Department of Rehabilitation at the First Affiliated Hospital of Zhengzhou University. Her research interests include cerebrovascular diseases and clinical nutrition.

Xiao Xi

Xiao Xi is a physician in the Department of Rehabilitation at Xijing Hospital. Her research interests include cerebrovascular diseases and clinical nutrition.

Qingmei Wang

Qingmei Wang is a professor of The Teaching Affiliate of Harvard Medical School. Her research interests include the rehabilitation of central system disorders.

Junfeng Yang

Junfeng Yang is a graduate of the First Affiliated Hospital of Zhengzhou University with a Master's degree in Rehabilitation Medicine and Physical Therapy. His research interests include nutritional support for critically ill patients.

Liugen Wang

Liugen Wang is an Associate Professor in the Department of Rehabilitation at the First Affiliated Hospital of Zhengzhou University. His research interests include the rehabilitation of neurocritical ill patients.

Heping Li

Heping Li is an associate professor in the Department of Rehabilitation at the First Affiliated Hospital of Zhengzhou University. His research interests include clinical nutrition.

Xun Luo

Xun Luo is a Ph.D. professor in the field of rehabilitation medicine. His research interests include rehabilitation and treatment of diseases of the central system.

Xi Zeng

Xi Zeng is a professor in the Department of Rehabilitation at the First Affiliated Hospital of Zhengzhou University. He is the deputy director of the Committee on Nutrition and Rehabilitation of the Chinese Society of Rehabilitation Medicine. He has been awarded several national patents and published numerous high-quality papers. His research interests include rehabilitating central system disorders and nutritional support for critically ill patients.