Risk factors of sepsis during hospitalization in patients with multiple trauma
Objective To observe the incidence of sepsis during hospitalization in patients with multiple trauma and to explore its risk factors.Methods Totally 816 patients with multiple trauma were diagnosed and treated in Qingdao Municipal Hospital from January 2021 to December 2023,and were divided into sepsis group(n=252)and non-sepsis group(n=564)according to whether sepsis occurred during hospitalization(within 28 d after admission).The cause of trauma,location of trauma,time from injury to admission,and the first Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Glasgow Coma Scale(GCS),Injury Severity Score(ISS),Sequential Organ Failure Assessment(SOFA)score,blood lactate,C-reactive protein(CRP),procalcitonin(PCT),and other indicators within 24 h after admission were compared between two groups.Propensity score matching with a 1∶1 ratio was used,with covariates including gender,age,and cause and location of trauma.After matching,the clinical scores,laboratory tests and other indicators were compared between two groups.Multivariate logistic regression was used to assess the influencing factors of sepsis during hospitalization in patients with multiple trauma.Results After matching,the time from trauma to admission and activated partial thromboplastin time were longer in sepsis group[24(13,24)h,34.72(26.09,44.59)s]than those in non-sepsis group[19(8,24)h,28.90(22.51,36.87)s](Z=-3.108,P=0.003;Z--4.694,P＜0.001).The APACHEⅡ score,ISS,SOFA score,mechanical ventilation ratio,white blood cell count,neutrophil/lymphocyte ratio,blood lactate,CRP and PCT were higher in sepsis group[17.0(14.0,22.0),25.0(21.0,28.0),9.0(6.0,13.0),92.5％,11.06× 109/L(9.36× 109/L,13.03×109/L),2.87(2.27,3.40),2.80(2.34,3.33)mmol/L,58.35(34.54,90.57)mg/L,0.81(0.62,2.24)μg/L]than those in non-sepsis group[14.0(11.0,17.0),23.0(20.0,23.5),5.5(4.0,9.0),66.3％,10.37 × 109/L(8.95 × 109/L,12.33 × 109/L),2.03(1.63,2.40),1.96(1.76,2.19)mmol/L,40.70(22.11,59.82)mg/L,0.41(0.24,0.60)μg/L](Z=-6.501,Z=4.969,Z=-9.087,x2=52.775,Z=-3.608,Z=-13.143,Z=-15.649,Z=-7.387,Z=-12.185;all P values＜0.05).The GCS,red blood cell count and platelet count were lower in sepsis group[5.0(4.0,8.0),(3.29±0.89)× 1012/L,(122.00±65.64)× 109/L]than those in non-sepsis group[8.5(5.0,12.0),(3.65±0.97)× 1012/L,(157.21±69.51)× 109/L](Z=-8.464,t=-4.295,t=-5.846;all P values＜0.05).Time from trauma to admission(OR=1.088,95％CI:1.014-1.167,P=0.018),APACHEⅡ score(OR=1.431,95％CI:1.216-1.684,P＜0.001),GCS(OR=0.767,95％CI:0.640-0.918,P=0.004),ISS(OR=1.352,95％CI:1.140-1.604,P=0.001),SOFA score(OR=1.513,95％CI:1.248-1.833,P＜0.001),blood lactate level(OR=2.037,95％CI:1.454-2.852,P=0.003),CRP level(OR=1.041,95％CI:1.020-1.064,P＜0.001),and PCT level(OR=3.106,95％CI:1.410-6.842,P=0.005)were the influencing factors of sepsis during hospitalization in patients with multiple trauma.Conclusion Long time from trauma to admission,high APACHE Ⅱ score,high ISS,high SOFA score,high blood lactate level,high CRP level,high PCT level,and low GCS indicate a high risk of sepsis during hospitalization in patients with multiple trauma.
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