Risk factors for sepsis development in trauma patients admitted to the ICU in Japan: a retrospective cohort study using the Japan trauma data bank.

Abstract

To clarify the epidemiology and risk factors for sepsis among trauma patients admitted to the intensive care unit (ICU) using the Japan Trauma Data Bank (JTDB). Retrospective cohort study. Analysis of nationwide JTDB data collected between 2004 and 2019 in Japan. A total of 126 433 adult trauma patients with an Abbreviated Injury Scale score ≥3 who survived for at least 72 hours after ICU admission were included. The primary outcome was in-hospital mortality among patients who developed sepsis after trauma. The secondary outcome was identification of risk factors associated with post-traumatic sepsis using multivariable logistic regression analysis. Sepsis developed in 972 patients (0.77%) and was associated with significantly higher in-hospital mortality compared with patients without sepsis (42.4% vs 4.6%, p<0.001), as well as longer hospital stay (47 vs 20 days, p<0.001). Independent risk factors for sepsis included older age (adjusted OR (aOR) 1.02, 95% CI 1.02 to 1.03), male sex (aOR 1.48, 95% CI 1.27 to 1.73), higher Injury Severity Score (ISS) (aOR 1.58, 95% CI 1.39 to 1.80), blood transfusion within 24 hours of arrival (aOR 2.78, 95% CI 2.36 to 3.26), abdominal or pelvic trauma (aOR 2.28, 95% CI 1.91 to 2.73) and lower extremity trauma (aOR 1.66, 95% CI 1.42 to 1.94). Conversely, head trauma was associated with a lower risk of sepsis (aOR 0.67, 95% CI 0.55 to 0.80). Similar trends were observed in subgroup analyses stratified by ISS. Although post-traumatic sepsis was uncommon, it was associated with markedly increased mortality. Older age, male sex, severe injury, early blood transfusion and abdominal/pelvic or lower extremity trauma were identified as major risk factors for sepsis after trauma.