Proportion, etiology, predictors, and clinical outcomes of sepsis in neurosurgical patients: a systematic review and meta-analysis protocol

Abstract Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, with in-hospital mortality rate exceeding 30% in critically ill patients. The increasing burden of sepsis in neurosurgical patients is a complex and poorly understood clinical challenge, underscoring the need for evidence-informed decision-making. This review aims to assess the proportion, etiology, predictors, and clinical outcomes in sepsis in neurosurgical patients. A systematic review and meta-analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Databases to be searched include PubMed, Embase, and Scopus from database inception to date. We will include original peer-reviewed articles reporting primary data. Additionally, reference lists of relevant reviews will be screened for additional eligible studies. Two independent reviewers will screen records, extract data, and assess risk of bias using Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.00 tool. In meta-analysis, the effect will be measured using proportions, odds ratios, relative risks, or mean differences, with their 95% confidence intervals. The I2 and τ2 will describe heterogeneity. Where applicable, meta-regression, subgroup, and sensitivity analyses will be conducted to explore sources of heterogeneity. About 95% prediction intervals will measure the expected range of the effect in future studies. Ethical approval is not required. Findings are expected to inform more effective treatment guidelines, while also guiding public health strategies through optimized resource allocation, increased investment in prophylactic and postoperative care, and evidence-based policy development. Systematic Review Registration: The protocol has been registered on the International Prospective Register of Systematic Review (CRD420251088061).