J. O. Hwabejire1, C. E. Nembhard1, T. A. Oyetunji2, T. Seyoum1, S. M. Siram1, E. E. Cornwell1, W. R. Greene1 1Howard University College Of Medicine,Surgery,Washington, DC, USA 2Children’s Mercy Hospital,Surgery,Kansas City, MO, USA
Introduction: Post-traumatic sepsis is a potentially lethal condition. While ‘multiple organ failure’ is often the labeled culprit for the cause of death, it is important to identify specific factors that may increase mortality in this setting. We hypothesize that pre-injury variables contribute significantly to mortality after post-traumatic sepsis.
Methods: The National Trauma Data Bank data sets for 2008-2010 were retrospectively examined. ICD-9 diagnostic codes 995.91 and 995.92 were used to identify subjects aged ≥ 16 with sepsis. Survivors were compared with non-survivors using demographic, injury-related, co-morbid, and other clinical variables. The primary outcome was mortality. Univariate and multivariate analyses were done to determine predictors of mortality.
Results: A total of 1486 patients were included, with a mean age of 55, in a predominantly male population (72%). Whites made up 60% and Blacks 17%. Mortality was 15% in those who had sepsis without organ dysfunction and increased to 38% in those with sepsis plus organ dysfunction. There was no difference in Injury Severity Score, emergency room systolic BP, pulse rate, temperature, oxygen saturation, GCS, ICU days or ventilation days between survivors and non-survivors. Compared to survivors, non-survivors were older (62±21 vs. 52±21, p<0.001), had a lower respiratory rate (16±10 vs. 17±10, p=0.045), more likely to be female (33% vs. 25%, p=0.002), transferred from another facility (32% vs. 26%, p=0.021), and had pre-injury bleeding disorder (41% vs. 25%, p<0.001), congestive heart failure (40% vs. 26%, p<0.001), DNR status (71% vs. 26%, p<0.001), history of myocardial infarction (45% vs. 26%, p=0.002) or hypertension (30% vs. 25%, p=0.04). Independent predictors of mortality in patients with sepsis were age (OR:1.02, CI:1.01-1.03, p<0.001), bleeding disorder (OR:1.80, CI:1.27-2.55, p=0.001) and DNR status (OR:4.99, CI:2.01-12.44, p=0.001).
Conclusion: Age, pre-injury bleeding disorder and DNR status are independent determinants of mortality in post-traumatic sepsis. Prompt attention to correction of coagulopathy, especially in older patients may be life-saving in this condition.