Early risk factors for sepsis in patients with severe blunt trauma

Flores, J.M.; Jiménez, P.I.; Rincón, M.D.; Márquez, J.A.; Navarro, H.; Arteta, D.; Murillo, F.

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Volume 32, Issue 1 , Pages 5-12, January 2001

Early risk factors for sepsis in patients with severe blunt trauma

J.M. Flores
- Department of Critical Care and Emergency Medicine, Servicio de Cuidados Crı́ticos y Urgencias (UCI-HRT), Hospital Universitario Virgen del Rocı́o, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
P.I. Jiménez
- Department of Critical Care and Emergency Medicine, Servicio de Cuidados Crı́ticos y Urgencias (UCI-HRT), Hospital Universitario Virgen del Rocı́o, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
M.D. Rincón
- Department of Critical Care and Emergency Medicine, Servicio de Cuidados Crı́ticos y Urgencias (UCI-HRT), Hospital Universitario Virgen del Rocı́o, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
J.A. Márquez
- Department of Critical Care and Emergency Medicine, Servicio de Cuidados Crı́ticos y Urgencias (UCI-HRT), Hospital Universitario Virgen del Rocı́o, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
H. Navarro
- At present, Dr Navarro is working in the Laboratory Section of the Centre for Labour Hygiene and Security of Jaén (Spain).
- Department of Biochemistry, Hospital Universitario Virgen del Rocı́o, Sevilla, Spain
D. Arteta
- Department of Critical Care and Emergency Medicine, Servicio de Cuidados Crı́ticos y Urgencias (UCI-HRT), Hospital Universitario Virgen del Rocı́o, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
F. Murillo
- Department of Critical Care and Emergency Medicine, Servicio de Cuidados Crı́ticos y Urgencias (UCI-HRT), Hospital Universitario Virgen del Rocı́o, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
- Corresponding author. Tel.: +34-95-4248153; fax: +34-95-4248294

Accepted 30 May 2000.

Abstract

We studied 43 patients with blunt trauma (injury severity score, ≥25), age >14 years and length of the intensive care unit (ICU) stay >48 h in order to estimate the frequency of sepsis and to identify early risk factors related to its development. Clinical data were collected during the first 24 h and several inflammatory mediators were determined from serum samples of the first 2 days after injury.

Twenty-one patients (48.8%) met sepsis criteria during their ICU stay, 9 (20.9%) fulfilled only criteria for sepsis; 6 (13.9%) fulfilled criteria for severe sepsis and another 6 (13.9%) criteria for septic shock.

An APACHE II score ≥14, the presence of hypovolemic shock, the need for three or more units of blood to be transfused and the administration of a total volume of fluids ≥10 l were all factors associated significantly with the development of sepsis. In the multivariant analysis, the need for a total volume of fluids ≥10 l was the only independent risk factor (adjusted odds ratio=10.49, 95% CI, 2.34–47.02; P=0.002). No significant differences were documented in relation to the behaviour of the serum markers.