The association of race and survival from sepsis after injury.
Genetic variation is associated with outcome disparity in critical illness. We sought to determine if race is independently associated with the development of posttraumatic sepsis and subsequent related mortality. Our Intensive Care Unit database was queried for admissions from January 1, 2000 to June 30, 2007. Patients were prospectively followed for sepsis (Any four of the following symptoms: temperature > or =38 degrees C, heart rate (HR) > or =90 b/m, RR > or =20 b/m (or PaCO2 < or =32 mm Hg), white blood cell count (WBC) > or =12, or vasopressor requirement all with an infectious source). White, Black, Hispanic, and Asian groups were defined. "Other" race was excluded. Most of the 3998 study patients were male (3157, 79.0%). Blunt trauma (2661, 66.6%) predominated. Six-hundred-seventy-seven (16.9%) met sepsis criteria. Mortality was 14.0 per cent (560). Sepsis was increased in Asians versus all others combined (23.7% vs. 16.1%). Race was independently associated with sepsis (adjusted odds ratio (OR) 1.12 (1.01-1.24), P value = 0.03). Sepsis associated mortality was 36.9 per cent (250/677). Black race demonstrated an increased survival versus all others after sepsis (25.4% vs. 37.7%) but this was not statistically significant (adjusted OR 0.96 (0.73-1.18), P value = 0.71). Race is independently associated with posttraumatic sepsis and possibly subsequent sepsis associated mortality. Further related study is needed with the ultimate goal of genetically based treatments for the prevention and treatment of sepsis after injury.
Plurad
David S
DS
Los Angeles County + University of Southern California Medical Center, Division of Trauma/Surgical Critical Care, Los Angeles, California 90033, USA. plurad@usc.edu
Lustenberger
Thomas
T
Kilday
Patrick
P
Zhu
Jay
J
Green
Donald J
DJ
Inaba
Kenji
K
Talving
Peep
P
Belzberg
Howard
H
Demetriades
Demetrios
D
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000208:ethnology* / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications* / Q000208:ethnology / Q000401:mortality