Jesper Eriksson1, Mikael Eriksson2, Olof Brattström3, Elisabeth Hellgren4, Ola Friman5, Andreas Gidlöf6, Emma Larsson7, Anders Oldner8. 1. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: jesper.b.eriksson@sll.se. 2. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: mikael.er.eriksson@sll.se. 3. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: olof.brattstrom@sll.se. 4. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden. Electronic address: elisabeth.hellgren@sll.se. 5. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden. Electronic address: ola.friman@sll.se. 6. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: andreas.gidlof@sll.se. 7. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: emma.ca.larsson@sll.se. 8. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Electronic address: anders.oldner@ki.se.
Abstract
PURPOSE: To evaluate the performance of the new SOFA-based sepsis definition in trauma patients. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: To evaluate the performance of the new SOFA-based sepsis definition in traumapatients. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Jesper Eriksson; Ann-Charlotte Lindström; Elisabeth Hellgren; Ola Friman; Emma Larsson; Mikael Eriksson; Anders Oldner Journal: Crit Care Explor Date: 2021-08-02