Becker Nils, Bülow Jasmin Maria, Franz Niklas, Marzi Ingo, Gebhard Florian, Eguchi Akiko, Rinderknecht Helen, Relja Borna
Department of Trauma, Hand, Plastic and Reconstructive Surgery, Translational and Experimental Trauma Research, Ulm University Medical Center, Ulm, Germany.
Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt, Germany.
Shock. 2025 Aug 1;64(2):187-197. doi: 10.1097/SHK.0000000000002626. Epub 2025 May 14.
Background: Infections are common complications in critical care, particularly in patients with severe multiple trauma, who are at elevated risk due to trauma-induced immunological changes. The heterogeneity of trauma patients complicates their initial assessment, yet timely recognition of patients at risk is crucial for guiding therapy and preventive measures. This study evaluated risk factors for sepsis and pneumonia in multiple trauma patients, incorporating a novel parameter: cell-derived extracellular particles (EPs) in plasma. Methods: Severely injured multiple trauma patients aged 18-80 years with an Injury Severity Score (ISS) ≥16 were included. Patient- and injury-related parameters were assessed at the injury site, admission and during clinical course. EP counts in plasma were measured at admission using intravesicular staining. Key variables from the first 24 h were analyzed to develop an early risk assessment score. Results: Among 124 patients, 16 developed pneumonia, and 29 developed sepsis. Pneumonia was associated with significantly lower Glasgow Coma Scale scores, higher intubation rates at the injury site and elevated Sequential Organ Failure Assessment scores at admission. Sepsis correlated with higher ISS, increased 24-h transfusion rates, lower leukocyte counts on day 1, and decreased levels of small EPs in plasma at admission. These variables formed the weighted Sepsis as Trauma Outcome Prediction (STOP) score. A STOP score >3 had a positive predictive value of 59.4% within 24 h upon admission to the emergency department for subsequent sepsis development. Conclusion: The risk of pneumonia in severely injured trauma patients was linked to impaired consciousness and preexisting organ-dysfunctions at admission. High-risk sepsis patients could be identified on day 1 following trauma using the STOP score, which incorporates ISS, 24-h transfusion rates, leukocyte counts at day 1, and small EP rates at admission. This novel scoring system could facilitate targeted therapeutic and preventive strategies for distinguishing high-risk populations.
感染是重症监护中的常见并发症，尤其是在严重多发伤患者中，由于创伤引起的免疫变化，他们面临的风险更高。创伤患者的异质性使他们的初始评估变得复杂，但及时识别有风险的患者对于指导治疗和预防措施至关重要。本研究评估了多发伤患者发生脓毒症和肺炎的风险因素，纳入了一个新参数：血浆中细胞衍生的细胞外颗粒（EPs）。方法：纳入年龄在18 - 80岁、损伤严重程度评分（ISS）≥16的重度受伤多发伤患者。在损伤部位、入院时和临床过程中评估患者和损伤相关参数。入院时使用囊内染色法测量血浆中的EP计数。分析前24小时内关键变量以制定早期风险评估评分。结果：124例患者中，16例发生肺炎，29例发生脓毒症。肺炎与格拉斯哥昏迷量表评分显著降低、损伤部位插管率较高以及入院时序贯器官衰竭评估评分升高相关。脓毒症与较高的ISS、24小时输血率增加、第1天白细胞计数较低以及入院时血浆中小EPs水平降低相关。这些变量构成了创伤后脓毒症结局预测（STOP）加权评分。STOP评分>3在急诊科入院后24小时内对随后发生脓毒症的阳性预测值为59.4%。结论：严重受伤创伤患者发生肺炎的风险与入院时意识障碍和既往存在的器官功能障碍有关。使用包含ISS、24小时输血率、第1天白细胞计数和入院时小EP率的STOP评分，可以在创伤后第1天识别高危脓毒症患者。这种新的评分系统可以促进针对高危人群的靶向治疗和预防策略。
