Acute Crit Care.  2018 Aug;33(3):130-134. 10.4266/acc.2018.00122.

Timing and Associated Factors for Sepsis-3 in Severe Trauma Patients: A 3-Year Single Trauma Center Experience

• Chung S
• Choi D
• Cho J
• Huh Y
• Moon J
• Kwon J
• Jung K
• Lee JC
• Kang BH

• KMID: 2436324
• DOI: http://doi.org/10.4266/acc.2018.00122

Abstract

BACKGROUND
We hypothesized that the recent change of sepsis definition by sepsis-3 would facilitate the measurement of timing of sepsis for trauma patients presenting with initial systemic inflammatory response syndrome. Moreover, we investigated factors associated with sepsis according to the sepsis-3 definition.
METHODS
Trauma patients in a single level I trauma center were retrospectively reviewed from January 2014 to December 2016. Exclusion criteria were younger than 18 years, Injury Severity Score (ISS) < 15, length of stay < 8 days, transferred from other hospitals, uncertain trauma history, and incomplete medical records. A binary logistic regression test was used to identify the risk factors for sepsis-3.
RESULTS
A total of 3,869 patients were considered and, after a process of exclusion, 422 patients were reviewed. Fifty patients (11.85%) were diagnosed with sepsis. The sepsis group presented with higher mortality (14 [28.0%] vs. 17 [4.6%], P < 0.001) and longer intensive care unit stay (23 days [range, 11 to 35 days] vs. 3 days [range, 1 to 9 days], P < 0.001). Multivariate analysis demonstrated that, in men, high lactate level and red blood cell transfusion within 24 hours were risk factors for sepsis. The median timing of sepsis-3 was at 8 hospital days and 4 postoperative days. The most common focus was the respiratory system.
CONCLUSIONS
Sepsis defined by sepsis-3 remains a critical issue in severe trauma patients. Male patients with higher ISS, lactate level, and red blood cell transfusion should be cared for with caution. Reassessment of sepsis should be considered at day 8 of hospital stay or day 4 postoperatively.

Keyword

intensive care units; risk factors; sepsis; wound and injuries

MeSH Terms

Erythrocyte Transfusion
Humans
Injury Severity Score
Intensive Care Units
Lactic Acid
Length of Stay
Logistic Models
Male
Medical Records
Mortality
Multivariate Analysis
Respiratory System
Retrospective Studies
Risk Factors
Sepsis
Systemic Inflammatory Response Syndrome
Trauma Centers*
Lactic Acid

Figure

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  Figure 1. Flow diagram of patient enrollment. ISS: Injury Severity Score; LOS: length of stay; Hx: history.

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