Comparison of the sepsis-2 and sepsis-3 definitions in severely injured trauma patients

To evaluate the performance of the new SOFA-based sepsis definition in trauma patients. A single-centre, retrospective, observational study. Primary outcome was 30-day mortality including a censoring analysis for early deaths. The primary outcome was evaluated with logistic regression, receiver oper...

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Bibliographic Details
Published in:Journal of critical care 2019-12, Vol.54, p.125-129
Main Authors: Eriksson, Jesper, Eriksson, Mikael, Brattström, Olof, Hellgren, Elisabeth, Friman, Ola, Gidlöf, Andreas, Larsson, Emma, Oldner, Anders
Format: Article
Language:English
Subjects:
Blood pressure
Classification
Coma
Comorbidity
Critical care
Data collection
Infections
Medicin och hälsovetenskap
Mortality
Patients
Researchers
Sepsis
Trauma
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Summary:To evaluate the performance of the new SOFA-based sepsis definition in trauma patients. A single-centre, retrospective, observational study. Primary outcome was 30-day mortality including a censoring analysis for early deaths. The primary outcome was evaluated with logistic regression, receiver operating characteristics (ROC) curves and Kaplan-Meier survival analyses. 722 severely injured patients were included between 2007 and 2016. 315 patients fulfilled the sepsis-2 criteria and 148 fulfilled the sepsis-3 criteria during the first ten days in the ICU. The odds ratios for 30-day mortality were 0.7 (CI 0.4–1.2) for sepsis-2 and 1.5 (CI 0.8–2.6) for sepsis-3. When censoring patients dying at day 1, sepsis-3 became associated with 30-day mortality whereas sepsis-2 did not. This finding was persistent and enhanced through continuing day-by-day censoring of early deaths. The same pattern was seen for the ROC curves analyses, censoring of early deaths resulted in significant discriminatory properties for sepsis-3 but not for sepsis-2. The sepsis-3 definition identifies much fewer patients and is more strongly associated with adverse outcomes than the sepsis-2 definition. The sepsis-3 definition seems to be useful in the post trauma setting. •The sepsis-3 criteria identify fewer patients than the sepsis-2 criteria in ICU admitted trauma victims.•Sepsis-3, but not sepsis-2, is associated with late mortality in trauma patients.•High admission SOFA as seen in trauma patients may affect the diagnosis of the SOFA-based sepsis-3.
ISSN:0883-9441
1557-8615
1557-8615
DOI:10.1016/j.jcrc.2019.08.019