Nasotracheal intubation and male sex as independent risk factors for ICU-acquired sinusitis in neurological patients: A retrospective cohort study

Hospital-acquired sinusitis is an underrecognized complication in critically ill neurological patients and may contribute to secondary infections and poor outcomes. This study aimed to evaluate the incidence and progression of sinusitis in the neurological intensive care unit (NICU) and to identify independent clinical risk factors. We conducted a single-center retrospective study of 250 patients admitted to the NICU at Beijing Tiantan Hospital between December 2020 and December 2021. Serial cranial computed tomography (CT) scans were evaluated using a modified Lund-MacKay scoring system. Sinusitis progression was defined as any increase in CT score from baseline. Univariable and multivariate logistic regression analyses were performed to determine independent predictors of sinusitis progression. Among the 250 patients (median age 63 years; 66% male), 58% had sinus opacification on admission. Progressive sinusitis was significantly associated with male sex (OR = 1.916, 95% confidence intervals: 1.002-3.666, P = .049) and nasotracheal intubation (OR = 5.792, 95% confidence intervals: 1.653-20.297, P = .006) as independent risk factors. Other factors, including hospital stay, diabetes, and pneumonia, were not significant in multivariate analysis. Nasotracheal intubation and male sex were independently associated with radiologic progression of ICU-acquired sinusitis in neurological patients. Implications for future research: prospective multicenter studies are warranted to test prevention and care protocols.