OBJECTIVE: To investigate the risk factors and their diagnostic efficacy for postoperative intestinal mucosal barrier dysfunction (IBD) following severe traumatic brain injury (sTBI). METHODS: There were 140 patients with sTBI enrolled in this study. Univariate and multivariate logistic regression analyses were conducted to assess the relationship between the clinical data and postoperative IBD in sTBI patients and determine the independent risk factors. The diagnostic efficacy of each risk factor was evaluated using the receiver operating characteristic curve and the area under the curve. RESULTS: According to the diagnostic criteria for IBD, the 140 enrolled patients were classified into the IBD group (n = 60) and the non-IBD group (n = 80). The levels of intraoperative initial intracranial pressure (iICP) of patients with IBD were significantly higher compared with those of patients without IBD (P <
0.001). Furthermore, intraoperative iICP presented high diagnostic efficacy for postoperative IBD (area under the curve = 0.91, 95% confidence interval 0.85-0.96, P <
0.001). Patients with higher intraoperative iICP were more prone to suffering unfavorable neurological outcomes. CONCLUSIONS: Intraoperative iICP could act as an independent and quantifiable predictor with high diagnostic efficacy for IBD in patients with sTBI after emergency surgery.