Yue Zhu,1,* Yangyang Jia,2,* Cheng Zhang,3 Hangyang Li,1 Peili Ding,1 Lingtong Huang,1 Guobin Wang,1 Hongliu Cai,1 Wenqiao Yu1 

1Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China; 2Department of Infection Management, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China; 3Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yue Zhu, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China, Email zhu_yue@zju.edu.cn

Purpose: Pneumonia is common in ICU patients with neurological dysfunction, but differences in pulmonary pathogen distribution in this population remain unclear. This study aimed to compare pathogen profiles, clinical features, and outcomes between ICU patients with and without neurological dysfunction.
Methods: This regional multicenter retrospective study included adult patients with severe pneumonia admitted to intensive care units (ICUs) in 11 hospitals across Zhejiang and Henan Provinces in mainland China between December 2018 and November 2023. All patients required invasive mechanical ventilation and underwent bronchoalveolar lavage fluid metagenomic next-generation sequencing (mNGS). Patients were classified into neurological dysfunction (ND) and without neurological dysfunction (WND) groups. Clinical characteristics, microbiological findings, and outcomes were compared. Propensity score matching (PSM) and Cox regression were used to assess prognosis.
Results: Among 1737 patients, 636 (41.8%) were in the ND group. After PSM, the ND group showed a higher 28-day ICU mortality rate and shorter time to death compared to the WND group. However, ND was not identified as an independent risk factor for 28-day mortality in Cox analysis. The prevalence of Acinetobacter baumannii, Klebsiella pneumoniae, Burkholderia, Serratia marcescens, Elizabethkingia, Clostridium spp. and Ureaplasma was higher in ND patients. Significant differences in the prevalence of Haemophilus influenzae, Fusarium oxysporum, Fusobacterium nucleatum, Porphyromonas gingivalis, Mycobacterium abscessus, Escherichia coli, varicella-zoster virus (VZV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV) were also observed.
Conclusion: ICU patients with neurological dysfunction exhibited distinct pulmonary pathogen profiles and worse outcomes. These findings may inform empirical antimicrobial strategies. Further prospective studies are warranted to validate these results.

Keywords: intensive care unit,ICU, glasgow coma scale,GCS, neurologic dysfunction,ND, pneumonia, clinical characteristics, metagenomic next-generation sequencing,mNGS, ICU length of stay,iculos, ICU 28-day mortality rate