Early risk factors for sepsis in patients with severe blunt trauma

We studied 43 patients with blunt trauma (injury severity score, greater than or equal to 25), age > 14 years and length of the intensive care unit (ICU) stay > 48 h in order to estimate the frequency of sepsis and to identify early risk factors related to its development. Clinical data were collected during the first 24 h and several inflammatory mediators were determined from serum samples of the first 2 days after injury. Twenty-one patients (48.8%) met sepsis criteria during their ICU stay, 9 (20.9%) fulfilled only criteria for sepsis; 6 (13.9%) fulfilled criteria for severe sepsis and another 6 (13.9%) criteria for septic shock. An APACHE II score greater than or equal to 14, the presence of hypovolemic shock, the need for three or more units of blood to be transfused and the administration of a total volume of fluids greater than or equal to 10 l were all factors associated significantly with the development of sepsis. In the multivariant analysis, the need for a total volume of fluids greater than or equal to 10 l was the only independent risk factor (adjusted odds ratio = 10.49, 95% CI, 2.34-47.02; P = 0.002). No significant differences were documented in relation to the behaviour of the serum markers. (C) 2001 Elsevier Science Ltd. Al rights reserved.