A new parameter for early prediction of sepsis in polytrauma patients: The 24hr leukocyte-gap (24hr-LCG)

Abstract text (incl. references and figure legends)

Introduction:

Prediction of septic complications after trauma remains challenging. Early post-traumatic episodes of both leukopenia and leucocytosis have been linked with sepsis in critically ill patients. The goal of the study was to develop and test a novel immune parameter to predict sepsis: the 24hr-leukocyte gap (24hr-LCG), defined as the difference between blood leukocyte numbers on admission and after 24 hours.

Methods:

Adults trauma patients were selected from a prospectively trauma registry. First, patients were grouped according to the absence or presence of septic complications. Thereafter, a multivariable regression analysis was utilized to identify specific predictive immune parameters for septic complications, septic shock and mortality.

Results:

A total of 1592 patient have been identified, of whom 251 developed sepsis. Patients diagnosed with sepsis were younger (p<0.002) and had higher ISS scores/worse hemodynamics on admission (p<0.001). The 24hr-LCG was identified as an independent immunological predictive parameter for sepsis by the multivariable analysis. Moreover, a 24hr-LCG ≥ 10, was associated with significantly increased rates of septic shock (12,4% vs. 4.3%, p<0.001) and mortality 6.0 vs. 2.7%, p=0.036), compared with other patients.

Conclusion:

This study is the first to show that a novel parameter: the 24hr-leukocyte gap is an independent early predictor for sepsis in trauma patients. The 24hr-LCG is an easy parameter to determine with conventional laboratory measurements. This parameter may support future decision making and more specifically timing of surgery in trauma patients.

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