Can APACHE II, SOFA, ISS, and RTS Severity Scores be Used to Predict Septic Complications in Multiple Trauma Patients?

Abstract Background: Physiological composite scores are used to predict mortality in multiple trauma patients. Sepsis is the leading cause of late mortality in trauma victims brought about by immune suppression due to homeostasis dysregulation. Objective: To determine whether APACHE II, SOFA, ISS and RTS scores can predict the occurrence of sepsis in multiple trauma patients. Methods: APACHE II, SOFA, ISS, and RTS scores were calculated during the first twenty-four hours after the injury for sixty-four adult poly-traumatic patients. The occurrence of infectious complications was investigated over a fourteenday period. The infection-free rates for the multiple trauma patients were considered as end-points in the Kaplan- Meier plot analysis. Results: For SOFA, a cutoff score of 4 points was identified as a predictor of the occurrence of sepsis, with 89% of the patients with SOFA<4 being infection-free, while 37% of those with SOFA>4 were infection-free (p<0.01). None of the patients with APACHE II≤5 points developed infections. Eighty-four percent of patients with APACHE II scores of 5-10 did not develop sepsis, while 49% with APACHE II≥11 were infection-free (p<0.01). A cutoff of 7 points was found to be most discriminative for RTS. Eighty-eight percent of the patients with RTS≥7 and 43% of those with RTS<7 were infection-free (p<0.01). Eighty-eight percent of patients with ISS<22 did not develop sepsis and 56% with ISS≥22 did not develop sepsis (p<0.01). Conclusion: APACHE II, SOFA, ISS, and RTS functional severity scores can predict mortality as well as the occurrence of sepsis in multiple trauma patients.

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Have Severity Scores a Place in Predicting Septic Complications in ICU Multiple Trauma Patients?

The Journal of Critical Care Medicine ◽

10.1515/jccm-2016-0023 ◽

2016 ◽

Vol 2 (3) ◽

pp. 107-108

Author(s):

Daniela Ionescu

Keyword(s):

Multiple Trauma ◽

Trauma Patients ◽

Septic Complications ◽

Severity Scores ◽

Multiple Trauma Patients

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Association of Initial Low Serum Selenium Level with Infectious Complications and 30-Day Mortality in Multiple Trauma Patients

Nutrients ◽

10.3390/nu11081844 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1844 ◽

Cited By ~ 1

Author(s):

Soon Bo Choi ◽

Yun Tae Jung ◽

Jae Gil Lee

Keyword(s):

Multiple Trauma ◽

Selenium Deficiency ◽

Infectious Complications ◽

Selenium Level ◽

Trauma Patients ◽

Serum Selenium ◽

Serum Selenium Levels ◽

Multiple Trauma Patients ◽

Serum Selenium Level ◽

Low Serum

Low serum selenium levels are commonly observed in critically injured multiple trauma patients. This study aimed to identify the association between initial serum selenium levels and in-hospital infectious complications in multiple trauma patients. We retrospectively reviewed multiple trauma patients admitted between January 2015 and November 2017. We selected 135 patients whose serum selenium levels were checked within 48 h of admission. Selenium deficiency was defined as a serum selenium level <70 ng/mL. Survival analyses of selenium deficiency and 30-day mortality were performed. Multivariate logistic regression analysis was performed to identify the association between initial serum selenium level and in-hospital infectious complications. Thirty-day mortality (8.3% vs. 0.0%; p = 0.018) and incidence rates of pneumonia (66.7% vs. 28.3%; p < 0.001) and infectious complications (83.3% vs. 46.5%; p < 0.001) were higher in patients with selenium deficiency than in patients without selenium deficiency. Kaplan–Meier survival cures also showed similar results (log rank test, p = 0.021). Of 135 patients, 76 (56.3%) experienced at least one infectious complication during admission. High injury severity score (ISS, odds ratio (OR) 1.065, 95% confidence interval (CI) 1.024–1.108; p = 0.002) and selenium deficiency (OR 3.995, 95% CI 1.430–11.156; p = 0.008) increased the risk of in-hospital infectious complications in multiple trauma patients. Patients with selenium deficiency showed higher 30-day mortality and higher risks of pneumonia and infectious complications.

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Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients

Journal of Trauma Nursing ◽

10.1097/jtn.0000000000000567 ◽

2021 ◽

Vol 28 (2) ◽

pp. 100-106

Author(s):

Mehmet Hilmi Höke ◽

Eren Usul ◽

Seda Özkan

Keyword(s):

Multiple Trauma ◽

Trauma Patients ◽

Trauma Severity ◽

Severity Scores ◽

Multiple Trauma Patients

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Plasma concentration of presepsin and its relationship to the diagnosis of infections in multiple trauma patients admitted to intensive care

Microbiologia Medica ◽

10.4081/mm.2017.6870 ◽

2017 ◽

Vol 32 (2) ◽

Cited By ~ 1

Author(s):

Monica Sparacino ◽

Emanuele Russo ◽

Sofia Vitali ◽

Arianna Torri ◽

Maria Federica Pedna ◽

...

Keyword(s):

Multiple Trauma ◽

Early Stage ◽

Trauma Treatment ◽

Trauma Patients ◽

Exclusion Criteria ◽

Septic Complications ◽

Traumatic Injuries ◽

The Mean ◽

Multiple Trauma Patients ◽

Early Diagnose

Background and aims: Septic complications represent the predominant cause of late death in poly-trauma patients. The necessity to differentiate septic from non septic patients is more relevant at the early stage of the illness in order to improve the clinical outcome and to reduce the mortality. The identification of a sensitive and specific, clinically reliable, biomarker capable to early recognize incoming septic complications in trauma patients whose expression is not influenced by concomitant traumatic injuries, is still a challenge for the researchers in the field. Materials and methods: A retrospective analysis on 48 adult patients (9 females and 39 males, mean age 47.6±19 years) with multiple trauma was performed. The inclusion criterion was to suffer from acute trauma since no more than 24 hours and the exclusion criteria were the following: antibiotic treatment on admission and maintained for more than 48 hours; on-going infection on admission not associated with trauma; treatment with immunosuppressors/ immunomodulants; age <18 years old. Presepsin was measured using an automated chemiluminescence analyser at 1, 3, 5 and 8 days post of hospitalization. The diagnosis of systemic inflammatory response syndrome (SIRS)/infection was established according to the criteria of the Surviving Sepsis Campaign. Results and conclusions: In patients with SIRS, the mean presepsin concentration was 917,08 (±69.042) ng/L vs 980,258 (±1951.32) ng/L in patients without SIRS (P=0.769). In the infected patients, the mean presepsin concentration was 1513.25 (±2296.54) ng/L vs 654.21 (±511,068) ng/L (P<0.05) calculated among the non infected upon admission. The plasma presepsin concentration increased progressively during the first 8 days of hospitalization. Presepsin concentration in the infected patients was significantly higher than in non-infected patients. On the other hands no significant differences were found in the plasma level of presepsin among patients with and without SIRS. Any other clinical condition related to the trauma did not affect presepsin. Our data clearly suggest that presepsin may be considered an helpful diagnostic tool to early diagnose sepsis in trauma patients.

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Predictive value of APACHE II score is improved by combination with bioelectrical impedance analysis in multiple trauma patients

Critical Care ◽

10.1186/cc291 ◽

1998 ◽

Vol 2 (Suppl 1) ◽

pp. P162

Author(s):

PHJ Mueller ◽

C Wachsmuth ◽

KF Waschke

Keyword(s):

Multiple Trauma ◽

Predictive Value ◽

Bioelectrical Impedance Analysis ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Apache Ii ◽

Apache Ii Score ◽

Trauma Patients ◽

Multiple Trauma Patients

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Endothelial Glycocalyx Degradation Is Associated With Early Organ Impairment in Multiple Trauma Patients

10.21203/rs.3.rs-303225/v1 ◽

2021 ◽

Author(s):

Feng Qi ◽

Hao Zhou ◽

Peng Gu ◽

Zhi-He Tang ◽

Bao-Feng Zhu ◽

...

Keyword(s):

Multiple Trauma ◽

Endothelial Glycocalyx ◽

Control Group ◽

Trauma Patients ◽

Metabolic Systems ◽

Organ Systems ◽

Severity Scores ◽

Multiple Trauma Patients ◽

Trauma Group ◽

Multiple Traumas

Abstract BackgroundEndothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in multiple trauma patients. MethodsA prospective observational study was conducted to enroll health participants (control group) and multiple traumas patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 hours and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 hours, and 28-day mortality in trauma group. ResultsThere were 45 multiple trauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P<0.001, respectively). SDC1 and HS were both positively correlated with prothrombin time, activated partial thromboplastin time, EVLW, N-terminal pro-B-type natriuretic peptide, myoglobin, creatinine, lactic acid, interleukin-6, and tumor necrosis factor-α (P<0.05, respectively). SDC1 and HS were both negatively correlated with Ca2+, anti-thrombin-III, PaO2/FiO2 ratio, pH and albumin (P<0.05, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. ROC curve analyses demonstrated SDC1 can predict the occurrence risk of AKI, TIC within 48h, and 28-day mortality. ConclusionsEG degradation was elevated significantly in multiple trauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems. Serum SDC1 is a valuable predictive indicator of early TIC, AKI risk, and 28-day mortality in multiple trauma patients.

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