The burden of infection in severely injured trauma patients and the relationship with admission shock severity

Cole, Elaine; Davenport, Ross; Willett, Keith; Brohi, Karim

doi:10.1097/ta.0b013e31829fdbd7

Cited by 32 publications

(30 citation statements)

References 35 publications

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“…The TBI cohort suffered a much higher mortality in the ERMODS group that appears to be a reflection of early deaths due to non-survivable head injury. The high rates of nosocomial infection in MODS are also described elsewhere (3, 16, 17); however, we observed greater than 100% increase in infections for the PRMODS group compared with ERMODS. Whether PRMODS may be induced by a second hit such as infection remains a hypothesis that requires further investigation.…”

Section: Discussionsupporting

confidence: 70%

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Shepherd

Cole

Brohi

2017

Shock

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Section: Discussionsupporting

confidence: 70%

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Shepherd

Cole

Brohi

2017

Shock

Self Cite

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“…The TBI cohort suffered a much higher mortality in the ERMODS group that appears to be a reflection of early deaths due to nonsurvivable head injury. The high rates of nosocomial infection in MODS are also described elsewhere (3,16,17); however, we observed greater than 100% increase in infections for the PRMODS group compared with ERMODS. Whether PRMODS may be induced by a second hit such as infection remains a hypothesis that requires further investigation.…”

Section: Discussioncontrasting

confidence: 40%

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

2017

Shock

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ABSTRACT-Background: Multiple organ dysfunction syndrome (MODS) is associated with poor outcomes for trauma patients. Different forms of MODS may exist and have different consequences. The ability to distinguish them clinically may have implications for prognosis and treatment. We wished to study whether prolonged MODS (PRMODS) could be observed as a distinct clinical entity to early resolving MODS (ERMODS) in critically injured patients. Methods: Adult major trauma patients recruited to a prospective observational study at a single major trauma center were eligible for inclusion. MODS was defined as Sequential Organ Failure Assessment (SOFA) score >5; and PRMODS as lasting >7 days. Time to recovery (TTR) was calculated as the number of days before the SOFA fell below the MODS threshold ( 5). Results: Five hundred ninety-five patients were enrolled of whom 285 developed ERMODS (48%) and 184 (31%) PRMODS. Organ dysfunction was more severe and protracted in PRMODS, especially in patients without brain injury (mean SOFA 11 vs. 6, Day 2, P < 0.001; TTR 17 vs. 3 days, P < 0.001). PRMODS exhibited higher rates of hepatic and renal dysfunction (84% vs. 56%; and 78% vs. 47%, P 0.001). Patterns of recovery were distinct in hepatic, renal, and neurological systems (TTR 15 vs. 4; 20 vs. 3; and 28 vs. 7 days, P < 0.01). PRMODS was associated with higher infection and mortality rates (91% vs. 41%; and 22% vs. 7%, P < 0.001). Conclusion: PRMODS appears common, a distinct clinical entity, and associated with worse patient outcomes. PRMODS may represent an important endpoint for studies evaluating outcomes following trauma.

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“…The risk of these infections is mainly determined by the severity of the injury and the following dysregulation of the immune response [1,2]. Over half of the severely injured patients admitted to the intensive care unit (ICU) develop an infection during hospitalization, generally after 5 days post-trauma [3]. Although infection-related mortality rates decreased over the past decades [4], severe infections such as sepsis remain a substantial cause of morbidity and mortality after trauma worldwide [5,6].…”

Section: Introductionmentioning

confidence: 99%

New automated analysis to monitor neutrophil function point-of-care in the intensive care unit after trauma

Hesselink

Spijkerman

Fraiture

et al. 2020

ICMx

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Background: Patients often develop infectious complications after severe trauma. No biomarkers exist that enable early identification of patients who are at risk. Neutrophils are important immune cells that combat these infections by phagocytosis and killing of pathogens. Analysis of neutrophil function used to be laborious and was therefore not applicable in routine diagnostics. Hence, we developed a quick and pointof-care method to assess a critical part of neutrophil function, neutrophil phagosomal acidification. The aim of this study was to investigate whether this method was able to analyze neutrophil functionality in severely injured patients and whether a relation with the development of infectious complications was present. Results: Fifteen severely injured patients (median ISS of 33) were included, of whom 6 developed an infection between day 4 and day 9 after trauma. The injury severity score did not significantly differ between patients who developed an infection and patients who did not (p = 0.529). Patients who developed an infection showed increased acidification immediately after trauma (p = 0.006) and after 3 days (p = 0.026) and a decrease in the days thereafter to levels in the lower normal range. In contrast, patients who did not develop infectious complications showed high-normal acidification within the first days and increased tasset to identify patients at risk for infections after trauma and to monitor the inflammatory state of these trauma patients. Conclusion: Neutrophil function can be measured in the ICU setting by rapid point-of-care analysis of phagosomal acidification. This analysis differed between trauma patients who developed infectious complications and trauma patients who did not. Therefore, this assay might prove a valuable asset to identify patients at risk for infections after trauma and to monitor the inflammatory state of these trauma patients.

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The burden of infection in severely injured trauma patients and the relationship with admission shock severity

Abstract: Prognostic/epidemiologic study, level II.

Cited by 32 publications

References 35 publications

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

New automated analysis to monitor neutrophil function point-of-care in the intensive care unit after trauma

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