Abstract
ObjectiveMultiple trauma is often accompanied by systemic inflammatory response syndrome (SIRS). The aim of this study was to investigate the impact of polymeric plasma substitutes on the development of SIRS or sepsis.MethodsWe included 2969 patients aged ≥16 years with an Injury Severity Score (ISS) >16 in this study. The sample was subdivided into three groups: patients who did not receive colloids and those who received <5L colloids and >5L colloids within the first 48 h. Data were analyzed using IBM SPSS® for Windows version 22.0; analysis of variance was used for continuous normally distributed data and Kruskal–Wallis test for categorical data. The predictive quality of colloid treatment was analyzed using the receiver operating characteristic (ROC) curves. Independent predictively was analyzed by binary logistic regression. Data were considered significant if P < 0.05. Data are presented as the mean ± standard deviation.ResultsThe SIRS score increased with the amount of colloid used (1.9 ± 1.4 vs. 2.4 ± 1.2 vs. 3.2 ± 0.9; P < 0.001). However, the predictive quality was low, with an area under the ROC of 0.693 for SIRS and 0.669 for sepsis (P < 0.001). Binary logistic regression revealed colloids as an independent factor for the development of SIRS and sepsis (odds ratios: SIRS 3.325 and sepsis 8.984; P < 0.001).ConclusionBesides other factors, colloids have a significant permissive effect and are independent predictors for the development of SIRS and sepsis in multiply injured patients. Trial registration ‘Retrospektive Analysen in der Chirurgischen Intensivmedizin’ No. St. V. 01-2008
Highlights
The most frequent cause of death in the young and productive adult population is trauma
In this retrospective cohort study, we asked how colloids influence the development of systemic inflammatory response syndrome (SIRS) and sepsis in patients with multiple traumas, apart from other factors with a significant permissive effect on the development of SIRS and sepsis
The lactate levels [3.3 ± 2.9 vs. 2.7 ± 2.0 vs. 3.1 ± 2.3; P < 0.001; Table 1] and base excess [–3.9 ± 6.1 vs. –3.3 ± 4.3 vs. –4.9 ± 4.6 (m Eq/L); P < 0.001; Table 1] were significantly elevated in patients from the group who received colloids >5L/48 h compared with the levels and base excess in patients from the group not receiving colloids and those in the group receiving colloids
Summary
The most frequent cause of death in the young and productive adult population is trauma. Overactivation of the immune system during SIRS leads to its depression through the compensatory anti-inflammatory response syndrome (CARS). In this phase, multiply injured patients are highly susceptible to infections, which increase their mortality and hospitalization. The absence of clear infusion protocols for colloidal plasma expanders may lead to involuntary mixtures of infused colloids. In this retrospective cohort study, we asked how colloids influence the development of SIRS and sepsis in patients with multiple traumas, apart from other factors with a significant permissive effect on the development of SIRS and sepsis
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