Document Type : Original Article
Authors
1
Emergency Medicine Department, Zahedan University of Medical Sciences, Balouchestan Boulevard, Main Campus of Zahedan University of Medical Sciences, Zahedan, Sistan and Baluchestan Province, Iran.
2
Department of Infectious Diseases, School of Medicine, Zabol University of Medical Science, Zabol, Iran
3
Department of Emergency Medicine, School of Medicine, Zabol University of Medical Science, Zabol, Iran
10.30491/tm.2026.584473.1936
Abstract
Introduction: Post-traumatic sepsis is a major cause of late mortality and prolonged morbidity following severe trauma. Identifying early clinical factors and potentially modifiable care-related exposures associated with post-traumatic sepsis is important for informing preventive strategies.
Methods: This prospective observational cohort study was conducted at a major teaching hospital. Consecutive adult polytrauma patients (Injury Severity Score [ISS] ≥16) admitted to the intensive care unit were enrolled. The primary outcome was SIRS-defined post-traumatic sepsis, diagnosed >48 hours after admission based on suspected or confirmed infection together with at least two systemic inflammatory response syndrome criteria. Univariate and multivariable logistic regression analyses were done to determine independent predictors.
Results: Out of a total of 197 patients, 21.8% (n=43) developed post-traumatic sepsis. Septic patients had a longer hospital stay (23.9 vs. 9.5 days, p<0.001) as well as the highest mortality (30.2% vs. 6.5%, p<0.001). In multivariable data analysis, three independent predictors were identified which include Head Abbreviated Injury Scale (AIS) (adjusted Odds Ratio [aOR]: 1.10, 95% CI: 1.03 to 1.18), Injury Severity Score (ISS) (aOR: 1.12, 95% CI: 1.04 to 1.20), and implantation of jugular/subclavian central venous catheter (CVC) (aOR: 6.96, 95% CI: 2.39 to 20.27). Predictive models created by employing these variables showed good apparent discrimination for post-traumatic sepsis in the development cohort (AUC: 0.87, 95% CI: 0.80 to 0.94). Survival and TRISS score were identified as significant independent predictors of in-hospital mortality with an adjusted odds ratio of 0.90 (95% CI 0.87-0.94), while transfusion of packed red blood cells had an aOR of 5.85 (95% CI 1.32-25.70).
Conclusion: The severity of head injury, the general grade of injury, and CVC placement are independent determinants of posttraumatic sepsis. Insertion of a jugular or subclavian CVC represents a prominent modifiable risk factor, while early predictive models can help with risk stratification of infection in the ICU.
Keywords
Subjects
