IBM and the University Hospital Zurich have developed an online tool for predicting outcomes of a patient with polytrauma, the IBM WATSON Trauma Pathway Explorer® . The three predicted outcomes are Systemic Inflammatory Response Syndrome (SIRS) and sepsis within 21 days as well as early death within 72 hours since the admission of the patient. The validated Trauma Pathway Explorer® offers insights into the most common laboratory parameters, such as procalcitonin (PCT). Sepsis is one of the most important complications after polytrauma, which is why it is crucial to detect it early. This study aimed to examine the time-dependent relationship between PCT values and sepsis, based on the WATSON technology. A total of 3653 patients were included, and ongoing admissions are incorporated continuously. Patients were split into two groups (sepsis and non-sepsis), and the PCT value was assessed for 21 days (1, 2, 3, 4, 6, 8, 12, 24, 48 hours, and 3, 4, 5, 7, 10, 14 and 21 days). The Mann-Whitney U-Test was used to evaluate the difference between the two groups. Binary logistic regression was utilized to examine the dependency of prediction. The Closest Top-left Threshold Method provided time-specific thresholds at which the PCT level is predictive for sepsis. At p <0.05, the data were declared significant. R was used to conduct all statistical analyses. The Mann-Whitney U-test showed a significant difference in PCT values in sepsis and non-sepsis patients between 12 and 24 hours, including post-hoc analysis (p <0.05). Likewise, the p-value started to be significant between 12 and 24 hours in the binary logistic regression (p <0.05). The threshold value of PCT to predict sepsis at 24 hours is 0.7μg/l, and at 48 hours 0.5μg/l. The presented time course of PCT levels in polytrauma patients shows the PCT as a separate predictor for sepsis relatively early. Even later, during the 21-day observation period, time-dependent PCT values may be utilized as a benchmark for the early and preemptive detection of sepsis, which may reduce death from septic shock and other deadly infectious episodes.

Department of Mathematics ETH Zurich 8092 Zurich Switzerland

Department of Orthopedic Surgery Masaryks University 62500 Brno Czech Republic

Department of Trauma Surgery University Hospital Zurich 8091 Zurich Switzerland

Division of Medical Sciences in Sportsmedicine Faculty of Sports Studies Masaryks University 62500 Brno Czech Republic

See more in PubMed

Pfeifer R, Tarkin IS, Rocos B, et al. Patterns of mortality and causes of death in polytrauma patients-Has anything changed? Injury 40 (2009): 907–911. PubMed

Giannoudis P Current concepts of the inflammatory response after major trauma. An update. Injury. Elsevier Ltd 34 (2003): 397–404. PubMed

Wafaisade A, Lefering R, Bouillon B, et al. Epidemiology and risk factors of sepsis after multiple trauma: An analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery. Crit Care Med 39 (2011): 621–628. PubMed

Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34 (2006): 1589–1596. PubMed

Jin H, Liu Z, Xiao Y, et al. Prediction of sepsis in trauma patients. Burns Trauma 2 (2014): 106–113. PubMed PMC

Ciriello V, Gudipati S, Stavrou PZ, et al. Biomarkers predicting sepsis in polytrauma patients : Current evidence. Injury 44 (2013): 1680–1692. PubMed

Sakran J, Michetti CP, Sheridan MJ, et al. The utility of procalcitonin in critically ill trauma patients. Journal of Trauma and Acute Care Surgery 73 (2012): 413–418. PubMed

Balci C, Sivaci R, Akbulut G, et al. Procalcitonin Levels as an Early Marker in Patients with Multiple Trauma under Intensive Care. The Journal of International Medical Research 37 (2009): 568. PubMed

Billeter A, Turina M, Seifert B, et al. Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: Useful indicators of septic infections in severely traumatized patients. World J Surg 33 (2009): 558–566. PubMed

Castelli GP, Pognani C, Cita M, et al. Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma. Crit Care Med 37 (2009): 1845–1849. PubMed

Keel M, Härter L, Reding T, et al. Pancreatic stone protein is highly increased during posttraumatic sepsis and activates neutrophil granulocytes. Crit Care Med 37 (2009): 1642–1648. PubMed

Castelli GP, Pognani C, Cita M, et al. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol 72 (2006): 69–80. PubMed

Wanner GA, Keel M, Steckholzer U, et al. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med 48 (2000): 950–957. PubMed

Mica L, Niggli C, Bak P, et al. Development of a Visual Analytics Tool for Polytrauma Patients: Proof of Concept for a New Assessment Tool Using a Multiple Layer Sankey Diagram in a Single-Center Database. World J Surg 44 (2020): 764–772. PubMed

Niggli C, Pape HC, Niggli P, et al. Validation of a Visual-Based Analytics Tool for Outcome Prediction in Polytrauma Patients (WATSON Trauma Pathway Explorer) and Comparison with the Predictive Values of TRISS. J Clin Med 10 (2021): 569. PubMed PMC

Collins GS, Reitsma JB, Altman DG, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): The TRIPOD Statement. BMC Med 13 (2015): 1–10. PubMed PMC

Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. Journal of Trauma 14 (1974): 187–196. PubMed

Bone RC, Alan FCM, Robert BFA, et al. Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies In Sepsis. Chest 101 (1992): 1644–1655. PubMed

Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). Journal of the American Medical Association. American Medical Association 315 (2016): 801–810. PubMed PMC

Gando S, Shiraishi A, Abe T, et al. The SIRS criteria have better performance for predicting infection than qSOFA scores in the emergency department. Sci Rep 10 (2020): 1–9. PubMed PMC

Mood C Logistic regression: Why we cannot do what we think we can do, and what we can do about it. Eur Sociol Rev 26 (2010): 67–82.

Gomila R Logistic or linear? Estimating causal effects of experimental treatments on binary outcomes using regression analysis. J Exp Psychol Gen 150 (2021): 700–709. PubMed

Sauaia A, Moore FA, Moore EE. Postinjury Inflammation and Organ Dysfunction. Critical Care Clinics 33 (2017): 167–191. PubMed PMC

Keel M, Trentz O. Pathophysiology of polytrauma Injury 36 (2005): 691–709. PubMed

Berwin JT, Pearce O, Harries L, et al. Managing polytrauma patients. Injury 51 (2020): 2091–2096. PubMed

Wiedermann FJ, Kaneider N, Egger P, et al. Migration of human monocytes in response to procalcitonin. Crit Care Med 30 (2020): 1112–1117. PubMed

Meisner M Update on procalcitonin measurements. Annals of Laboratory Medicine. Seoul National University 11 (2014): 263–273. PubMed PMC

Meisner M, Adina H, Schmidt J. Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patients. Crit Care 10 (2005): 5623. PubMed PMC

Oberholzer A, Keel M, Zellweger R, et al. Incidence of Septic Complications and Multiple Organ Failure in Severely Injured Patients Is Sex Specific. The Journal of Trauma: Injury, Infection, and Critical Care 48 (2000): 65–97. PubMed

Egger G, Aigner R, Glasner A, et al. Blood polymorphonuclear leukocyte migration as a predictive marker for infections in severe trauma: Comparison with various inflammation parameters. Intensive Care Med 30 (2004): 331–334. PubMed

Hensler T, Sauerland S, Lefering R, et al. The clinical value of procalcitonin and neopterin in predicting sepsis and organ failure after major trauma. Shock 20 (2003): 420–426. PubMed

Mica L, Pape HC, Niggli P, et al. New Time-Related Insights into an Old Laboratory Parameter: Early CRP Discovered by IBM Watson Trauma Pathway Explorer© as a Predictor for Sepsis in Polytrauma Patients. J Clin Med 10 (2021): 3269. PubMed PMC

Flores J, Jiménez P, Márquez J, et al. Early risk factors for sepsis in patients with severe blunt trauma. Injury 32 (2001): 5–12. PubMed

Waydhas C, Nast-Kolb D, Jochum M, et al. Inflammatory Mediators, Infection, Sepsis, and Multiple Organ Failure After Severe Trauma. Langenbecks Arch Surg 127 (1992): 460–467. PubMed

Dahl B, Schiødt F, Wians F, et al. Plasma concentration of Gc-globulin is associated with organ dysfunction and sepsis after injury. Crit Care Med 31 (2003): 152–156. PubMed

Giannoudis PV, Smith RM, Perry SL, et al. Immediate IL-10 expression following major orthopaedic trauma - relationship to anti-inflammatory response and subsequent development of sepsis. Intensive Care Med 26 (2000): 1076–1081. PubMed