Risk factors for sepsis development in trauma patients admitted to the ICU in Japan: a retrospective cohort study using the Japan trauma data bank.

OBJECTIVES: To clarify the epidemiology and risk factors for sepsis among trauma patients admitted to the intensive care unit (ICU) using the Japan Trauma Data Bank (JTDB). DESIGN: Retrospective cohort study. SETTING: Analysis of nationwide JTDB data collected between 2004 and 2019 in Japan. PARTICIPANTS: A total of 126 433 adult trauma patients with an Abbreviated Injury Scale score ≥3 who survived for at least 72 hours after ICU admission were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was in-hospital mortality among patients who developed sepsis after trauma. The secondary outcome was identification of risk factors associated with post-traumatic sepsis using multivariable logistic regression analysis. RESULTS: Sepsis developed in 972 patients (0.77%) and was associated with significantly higher in-hospital mortality compared with patients without sepsis (42.4% vs 4.6%, p<0.001), as well as longer hospital stay (47 vs 20 days, p<0.001). Independent risk factors for sepsis included older age (adjusted OR (aOR) 1.02, 95% CI 1.02 to 1.03), male sex (aOR 1.48, 95% CI 1.27 to 1.73), higher Injury Severity Score (ISS) (aOR 1.58, 95% CI 1.39 to 1.80), blood transfusion within 24 hours of arrival (aOR 2.78, 95% CI 2.36 to 3.26), abdominal or pelvic trauma (aOR 2.28, 95% CI 1.91 to 2.73) and lower extremity trauma (aOR 1.66, 95% CI 1.42 to 1.94). Conversely, head trauma was associated with a lower risk of sepsis (aOR 0.67, 95% CI 0.55 to 0.80). Similar trends were observed in subgroup analyses stratified by ISS. CONCLUSIONS: Although post-traumatic sepsis was uncommon, it was associated with markedly increased mortality. Older age, male sex, severe injury, early blood transfusion and abdominal/pelvic or lower extremity trauma were identified as major risk factors for sepsis after trauma.