Impact and Weight of Trauma Load and Inflammation Load Variables on the Severity and Outcome of Major Trauma Patients

Abstract

Background: Several conditions related to injury severity (trauma load) and systemic inflammatory response (SIRS) after major trauma could affect the outcome. The aim of this study was to assess the influence in the outcome of variables related to trauma and to systemic inflammation after major trauma. Materials and Methods: Prospective cohort study involving patients admitted to the trauma room of a level 1 trauma center. Variables related to the trauma load and to the inflammation load were collected in the first six hours after trauma. IL-6 was measured on admission and at 24, 48 and 72 hours. All variables were correlated with negative outcomes, namely ICU admission, ARDS development, MODS development and death. Univariate and multivariate analysis were performed. Results: Ninety nine patients (aged 31 years;, ISS-29) were enrolled. Regarding trauma load variables, in univariate analysis, severity scores were correlated with all the negative outcome variables, TBI severity with ICU admission and death and CT severity with development of ARDS. Regarding inflammation variables, hypothermia and lethal triad were correlated with MODS; SIRS with hypoperfusion, shock, hypothermia, hyperlactacidemia, coagulopathy and lethal triad with death. IL-6 and IL-10 also correlated with negative outcomes. In multivariate analysis, TRISS, hypothermia and shock in the first six hours and IL- 6 at 48 and 72 hours correlated either with MODS development or death. Conclusions: TRISS, shock and hypothermia in the first six hours and IL-6 level at 48 and 72 hours were independently and significantly associated with MODS development or with death. Avoidance or swift resolution of shock and hypothermia may well be the most important goal in the first six hours after major trauma.