{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:05:25Z","timestamp":1784189125961,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Infectious complications are frequent in neurological intensive care unit (ICU) patients and may contribute to in-hospital mortality. However, their independent association with in-hospital mortality in full neurological ICU cohorts remains insufficiently defined. This study evaluated documented hospital-course infectious complications as factors associated with in-hospital mortality in a six-year neurological ICU cohort. Methods: We performed a retrospective, single-center cohort study including all available neurological ICU admission episodes recorded between 1 January 2020 and 31 December 2025. The primary outcome was in-hospital mortality. Infectious variables included pneumonia, COVID-related pneumonia, urinary tract infection, pressure sore or pressure sore-related infection, sepsis-related coding, and any infectious complication. Multivariable logistic regression was used to assess independent associations with mortality. The primary model included individual infectious complications without Glasgow Coma Scale (GCS), while a GCS-adjusted model was used as a sensitivity analysis. Incremental model analysis, model validation\/calibration, and COVID-related sensitivity analyses were also performed. Results: The cohort included 5509 neurological ICU admission episodes; 999 ended in in-hospital death, corresponding to a mortality rate of 18.1%. Any infectious complication was documented in 1911 episodes (34.7%). Pneumonia was the most frequent infectious complication (22.2%) and remained independently associated with mortality in the primary model (adjusted OR 6.82, 95% CI 5.70\u20138.18; p &lt; 0.001) and in the GCS-adjusted model (adjusted OR 5.25, 95% CI 4.05\u20136.80; p &lt; 0.001). Sepsis-related coding, interpreted as a documentation-based marker of severe systemic infectious deterioration rather than formally adjudicated sepsis, showed the strongest adjusted association with death (adjusted OR 12.40, 95% CI 6.53\u201323.54; p &lt; 0.001). Urinary tract infection and pressure sore-related infection were associated with mortality in unadjusted analyses but not after adjustment. Conclusions: Pneumonia and sepsis-related coding were robustly and independently associated with in-hospital mortality. Infectious complications added mortality-related information beyond baseline clinical variables and should be integrated into neurological ICU risk assessment and infection-surveillance strategies.<\/jats:p>","DOI":"10.3390\/jcm15145562","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:34:23Z","timestamp":1784172863000},"page":"5562","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital-Course Infectious Complications Associated with In-Hospital Mortality in a Neurological Intensive Care Cohort: A Six-Year Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Simona Ioana Adriana","family":"Mlendea (G\u0103lbineanu)","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Bra\u0219ov County Emergency Clinical Hospital, 500326 Bra\u0219ov, Romania"},{"name":"Doctoral School in Medicine, \u201cTransilvania\u201d University of Bra\u0219ov, 500019 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4591-5039","authenticated-orcid":false,"given":"Alin","family":"Kraft","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, 031593 Bucharest, Romania"},{"name":"Department of General Surgery, \u201cGeneral Doctor Aviator Victor Anastasiu\u201d National Aeronautical and Space Medicine Institute, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Falup-Pecurariu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bra\u0219ov County Emergency Clinical Hospital, 500326 Bra\u0219ov, Romania"},{"name":"Faculty of Medicine, \u201cTransilvania\u201d University of Bra\u0219ov, 500019 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana Gianina","family":"Melicianu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Bra\u0219ov County Emergency Clinical Hospital, 500326 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren\u021biu D\u0103nu\u021b","family":"Nedelcu","sequence":"additional","affiliation":[{"name":"Doctoral School in Medicine, \u201cTransilvania\u201d University of Bra\u0219ov, 500019 Bra\u0219ov, Romania"},{"name":"Faculty of Medicine, \u201cTransilvania\u201d University of Bra\u0219ov, 500019 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s11910-019-0987-y","article-title":"Healthcare-Associated Infections in the Neurocritical Care Unit","volume":"19","author":"Busl","year":"2019","journal-title":"Curr. 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