Niggli Cédric, Vetter Philipp, Hambrecht Jan, Pape Hans-Christoph, Mica Ladislav
Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland.
J Clin Med. 2024 Mar 9;13(6):1570. doi: 10.3390/jcm13061570.
Sepsis is a leading cause of mortality in polytrauma patients, especially beyond the first week, and its management is vital for reducing multiorgan failure and improving survival rates. This is particularly critical in geriatric polytrauma patients due to factors such as age-related physiological alterations and weakened immune systems. This study aimed to investigate various clinical and laboratory parameters associated with sepsis in polytrauma patients aged < 65 years and ≥65 years, with the secondary objective of comparing sources of infection in these patient groups. A retrospective cohort study was conducted at the University Hospital Zurich from August 1996 to December 2012. Participants included trauma patients aged ≥16 years with an Injury Severity Score (ISS) ≥ 16 who were diagnosed with sepsis within 31 days of admission. Patients in the age groups < 65 and ≥65 years were compared in terms of sepsis development. The parameters examined included patient and clinical data as well as laboratory values. The statistical methods encompassed group comparisons with Welch's -test and logistic regression. A total of 3059 polytrauma patients were included in the final study. The median age in the group < 65 years was 37 years, with a median ISS of 28. In the patient group ≥ 65 years, the median age was 75 years, with a median ISS of 27. Blunt trauma mechanism, ISS, leucocytosis at admission, and anaemia at admission were associated with sepsis in younger patients but not in geriatric patients, whereas sex, pH at admission, lactate at admission, and Quick values at admission were not significantly linked with sepsis in either age group. Pneumonia was the most common cause of sepsis in both age groups. Various parameters linked to sepsis in younger polytrauma patients do not necessarily correlate with sepsis in geriatric individuals with polytrauma. Hence, it becomes critical to recognize imminent danger, particularly in geriatric patients. In this context, the principle of "HIT HARD and HIT EARLY" is highly important as a proactive approach to effectively address sepsis in the geriatric trauma population, including the preclinical setting.
脓毒症是多发伤患者死亡的主要原因，尤其是在第一周之后，其治疗对于减少多器官功能衰竭和提高生存率至关重要。由于年龄相关的生理改变和免疫系统减弱等因素，这在老年多发伤患者中尤为关键。本研究旨在调查年龄＜65岁和≥65岁的多发伤患者中与脓毒症相关的各种临床和实验室参数，次要目的是比较这些患者组的感染源。1996年8月至2012年12月在苏黎世大学医院进行了一项回顾性队列研究。参与者包括年龄≥16岁、损伤严重程度评分（ISS）≥16且在入院31天内被诊断为脓毒症的创伤患者。比较了年龄＜65岁和≥65岁组患者脓毒症的发生情况。检查的参数包括患者和临床数据以及实验室值。统计方法包括使用韦尔奇t检验和逻辑回归进行组间比较。最终研究共纳入3059例多发伤患者。年龄＜65岁组的中位年龄为37岁，中位ISS为28。在年龄≥65岁的患者组中，中位年龄为75岁，中位ISS为27。钝性创伤机制、ISS、入院时白细胞增多和入院时贫血与年轻患者的脓毒症相关，但与老年患者无关，而性别、入院时pH值、入院时乳酸水平和入院时Quick值在两个年龄组中均与脓毒症无显著关联。肺炎是两个年龄组中脓毒症最常见的原因。年轻多发伤患者中与脓毒症相关的各种参数不一定与老年多发伤患者的脓毒症相关。因此，识别即将到来的危险至关重要，尤其是在老年患者中。在这种情况下，“重拳出击、尽早治疗”原则作为一种积极主动的方法，对于有效应对老年创伤人群中的脓毒症（包括临床前阶段）非常重要。
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