When trauma turns septic: Associated factors and focus-specific mortality in 61,399 patients from the TraumaRegister DGU®

Abstract

PURPOSE: Sepsis is a critical complication after severe trauma. This study aimed to identify factors associated with sepsis, to characterise sepsis foci in relation to injury pattern, and to evaluate the association of sepsis with multiple organ failure (MOF) and in-hospital mortality. METHODS: This retrospective cohort study analysed TraumaRegister DGU® data (2020-2024). Patients aged ≥ 16 years with a worst injury of at least Abbreviated Injury Scale (AIS) grade 3 and admission to the intensive care unit (ICU) were included; those transferred out early (<48 h) or with missing sepsis documentation were excluded. Sepsis was defined according to Sepsis-3 criteria as documented in the registry. Multivariable logistic regression identified factors associated with sepsis. RESULTS: Of 61,399 patients, 3486 (5.7%) developed sepsis. Septic patients had markedly longer ICU stays (median 19 [IQR 10-31] vs 3 [2-8] days, p < 0.001). MOF occurred in 17.8% overall and was more frequent in septic than non-septic patients (68.7% vs 14.7%). The predominant focus was pulmonary (63.6%), followed by abdominal (8.7%). Overall in-hospital mortality was 15.8% (n = 9696); sepsis-associated mortality was 31.5%. Among specified foci, case-fatality was highest for abdominal (38.0%) and pulmonary (32.3%) sepsis. Early ventilation present at ICU admission showed the strongest association with sepsis (odds ratio 2.85, 95% confidence interval 2.62-3.09). CONCLUSION: Sepsis after severe trauma is associated with prolonged ICU stay, a high rate of MOF, and increased in-hospital mortality. Abdominal and pulmonary foci carry the highest case-fatality among specified sources. Early recognition of associated factors and targeted management are essential to improve outcome.