Comparison of Sepsis-Related Outcomes in Trauma versus Non-Trauma Surgical ICU Patients: A Cross-Sectional Study

Sepsis remains a major cause of morbidity and mortality in critically ill patients admitted to surgical intensive care units (SICUs). Despite advances in antimicrobial therapy, organ support, and evidence-based protocols, sepsis continues to account for substantial healthcare burden worldwide. According to the World Health Organization, sepsis affects millions annually and is associated with high case fatality rates, particularly in low- and middle-income countries [1]. Surgical ICU patients are especially vulnerable due to the presence of invasive procedures, postoperative immunosuppression, prolonged mechanical ventilation, and exposure to multidrug-resistant organisms.

Trauma patients constitute a unique subgroup within surgical ICUs. Severe trauma triggers a complex cascade of inflammatory and immunological responses, often described as systemic inflammatory response syndrome (SIRS), which may predispose patients to secondary infections and sepsis. The “two-hit” hypothesis suggests that initial traumatic insult primes the immune system, and subsequent infections can lead to exaggerated inflammatory responses, culminating in organ dysfunction [2]. In contrast, non-trauma surgical ICU patients—such as those undergoing major abdominal, vascular, or oncologic surgeries—may develop sepsis due to surgical site infections, anastomotic leaks, or device-related infections [3].

The definitions and diagnostic criteria for sepsis have evolved over time, with the Society of Critical Care Medicine and the European Society of Intensive Care Medicine proposing the Sepsis-3 criteria, which emphasize life-threatening organ dysfunction caused by a dysregulated host response to infection [4]. These updated criteria highlight the importance of Sequential Organ Failure Assessment (SOFA) scoring in identifying high-risk patients. However, the clinical presentation, progression, and outcomes of sepsis may vary significantly between trauma and non-trauma populations due to differences in baseline physiology, injury patterns, surgical complexity, and comorbid conditions.

Previous studies have reported varying mortality rates, length of ICU stay, ventilator dependency, and incidence of septic shock between trauma and non-trauma patients [5]. Trauma patients are often younger and previously healthy, which may confer some survival advantage, whereas non-trauma surgical patients frequently have multiple comorbidities such as diabetes, malignancy, or chronic organ dysfunction that may worsen outcomes. Understanding these distinctions is crucial for resource allocation, risk stratification, and tailoring management strategies in surgical ICUs.

Aim

To compare sepsis-related outcomes in trauma versus non-trauma surgical ICU patients.

Objectives

1.             To determine the incidence of sepsis and septic shock among trauma and non-trauma surgical ICU patients.

2.             To compare mortality, duration of mechanical ventilation, and length of ICU stay between the two groups.

3.             To assess organ dysfunction severity using SOFA score in trauma versus non-trauma surgical ICU patients.

Table 1: To compare sepsis-related outcomes in trauma versus non-trauma surgical ICU patients (N = 100)

Table 1 compares the baseline characteristics and sepsis-related clinical variables between trauma (n = 52) and non-trauma (n = 48) surgical ICU patients. The mean age of trauma patients was significantly lower (38.6 ± 11.2 years; 95% CI: 35.5–41.7) compared to non-trauma patients (56.8 ± 12.6 years; 95% CI: 53.2–60.4), and this difference was highly statistically significant (p < 0.001). Male predominance was observed in both groups but was significantly higher in trauma patients (75.0%) compared to non-trauma patients (56.3%) (p = 0.041).

Comorbid conditions such as diabetes mellitus and hypertension were significantly more common in non-trauma patients. Diabetes was present in 47.9% of non-trauma patients versus 21.2% in trauma patients (p = 0.006), while hypertension was noted in 54.2% of non-trauma patients compared to 26.9% in trauma patients (p = 0.004). Ventilator requirement was slightly higher in trauma patients (65.4%) than non-trauma patients (60.4%); however, this difference was not statistically significant (p = 0.604).

Table 2 To determine the incidence of sepsis and septic shock among trauma and non-trauma surgical ICU patients (N = 100)

Table 2 presents the incidence of sepsis and septic shock among trauma and non-trauma surgical ICU patients. The incidence of sepsis was comparable between trauma (71.2%) and non-trauma (70.8%) groups, with no statistically significant difference (p = 0.964). Similarly, culture-positive infections were almost identical in both groups (63.5% in trauma vs 64.6% in non-trauma; p = 0.907).

Although septic shock was more frequent among non-trauma patients (45.8%) compared to trauma patients (30.8%), the difference did not reach statistical significance (p = 0.119). Gram-negative organisms were more commonly isolated in non-trauma patients (58.3%) than trauma patients (46.2%), but again without statistical significance (p = 0.218).

Table 3 compares outcome parameters between trauma and non-trauma surgical ICU patients. ICU mortality was higher among non-trauma patients (35.4%) compared to trauma patients (21.2%), though the difference was not statistically significant (p = 0.113).

Table 3: To compare mortality, duration of mechanical ventilation, and length of ICU stay between the two groups (N = 100)

However, significant differences were observed in duration of mechanical ventilation and length of ICU stay. Non-trauma patients required longer mechanical ventilation (8.9 ± 3.4 days; 95% CI: 7.9–9.9) compared to trauma patients (6.8 ± 2.9 days; 95% CI: 6.0–7.6), and this difference was statistically significant (p = 0.002). Similarly, the mean ICU stay was significantly prolonged in non-trauma patients (12.6 ± 4.2 days) compared to trauma patients (9.4 ± 3.7 days) (p < 0.001). Vasopressor use was more frequent in non-trauma patients (50.0%) than trauma patients (36.5%), but this difference was not statistically significant (p = 0.166).

Table 4: To assess organ dysfunction severity using SOFA score in trauma versus non-trauma surgical ICU patients (N = 100)

Table 4 evaluates organ dysfunction severity using SOFA score in both groups. Non-trauma patients had significantly higher initial SOFA scores (8.3 ± 2.8; 95% CI: 7.5–9.1) compared to trauma patients (6.7 ± 2.4; 95% CI: 6.0–7.4) (p = 0.003). Similarly, peak SOFA scores were significantly higher in non-trauma patients (10.4 ± 3.6) than trauma patients (8.2 ± 3.1) (p = 0.001).

Renal dysfunction was significantly more common in non-trauma patients (47.9%) compared to trauma patients (26.9%) (p = 0.028). Respiratory dysfunction was also more frequent in non-trauma patients (66.7%) than trauma patients (55.8%), though the difference was not statistically significant (p = 0.259).

Baseline Characteristics (Table 1): Trauma patients in our study were significantly younger (38.6 ± 11.2 years) compared to non-trauma patients (56.8 ± 12.6 years), which is consistent with global epidemiological patterns where trauma predominantly affects young males. Sartelli M et al. (2021)[6] in the SOAP study also reported that trauma ICU populations were generally younger and predominantly male. Similarly, Chebl RB et al. (2025)[2] noted that septic patients without trauma were typically older and had more comorbid conditions, which influenced outcomes.

In our study, diabetes mellitus and hypertension were significantly more common in non-trauma patients (47.9% and 54.2%, respectively). This aligns with findings by Dvorak JE et al. (2024)[3], who reported higher sepsis incidence and worse outcomes among patients with chronic comorbidities such as diabetes and cardiovascular disease. Ghazaly HF et al. (2023)[4] also emphasized that pre-existing comorbidities significantly modify host response and organ dysfunction in sepsis.

The higher male predominance in trauma patients (75%) is consistent with epidemiological trauma registries reported by Espat NN et al. (2025)[5], highlighting the systemic inflammatory response triggered by traumatic injury in young males.

Incidence of Sepsis and Septic Shock (Table 2): The overall incidence of sepsis was nearly identical between trauma (71.2%) and non-trauma (70.8%) groups. This suggests that once admitted to the surgical ICU, infection risk becomes comparable regardless of admission cause. Velonas G et al. (2025)[1] reported similar sepsis incidence across surgical and trauma ICUs.

Although septic shock was more frequent in non-trauma patients (45.8% vs 30.8%), this difference was not statistically significant. However, Sartelli M et al. (2021)[6] in the Sepsis-3 consensus highlighted that advanced age and comorbidities increase the likelihood of progression to septic shock, which may explain the trend seen in our non-trauma cohort.

Culture positivity rates were comparable between groups, and Gram-negative organisms predominated in both groups. This observation aligns with findings by Iranya RN et al. (2022)[7], who reported Gram-negative bacteria as the leading pathogens in surgical ICU sepsis, particularly in abdominal and device-related infections.

Mortality and ICU Outcomes (Table 3): ICU mortality was higher in non-trauma patients (35.4%) compared to trauma patients (21.2%), although not statistically significant. Salama AH et al. (2022)[8] demonstrated that older age and comorbidity burden were independent predictors of mortality in severe sepsis, supporting our observed mortality trend.

Significantly longer duration of mechanical ventilation and ICU stay in non-trauma patients reflects greater disease severity and organ dysfunction. Similar findings were reported by Udovicic I et al. (2021)[9], who showed that septic patients with medical or non-trauma surgical causes required prolonged organ support compared to trauma patients.

Vasopressor use was higher in non-trauma patients, corresponding with the higher incidence of septic shock and higher SOFA scores in this group.

Organ Dysfunction Severity (Table 4): Non-trauma patients demonstrated significantly higher initial and peak SOFA scores, indicating greater organ dysfunction severity. This finding aligns with Sepsis-3 criteria emphasizing SOFA as a predictor of mortality and disease severity Basodan N et al. (2022)[10].

Renal dysfunction was significantly more common in non-trauma patients (47.9%), likely related to advanced age and comorbid diabetes and hypertension. Verheul EA et al. (2025)[11] reported that renal dysfunction is a common early manifestation in elderly septic patients. Respiratory dysfunction was common in both groups, consistent with literature showing lungs as the most frequently involved organ in sepsis Velonas G et al. (2025)[1].

This cross-sectional comparative study demonstrated that although the overall incidence of sepsis was similar between trauma and non-trauma surgical ICU patients, significant differences existed in baseline characteristics and clinical outcomes. Trauma patients were younger and predominantly male, whereas non-trauma patients had a significantly higher burden of comorbidities such as diabetes mellitus and hypertension. Non-trauma patients exhibited higher initial and peak SOFA scores, greater incidence of renal dysfunction, longer duration of mechanical ventilation, and prolonged ICU stay. Although ICU mortality was higher among non-trauma patients, the difference was not statistically significant.

These findings suggest that while trauma-induced sepsis reflects an acute inflammatory response in otherwise physiologically resilient individuals, sepsis in non-trauma surgical patients is often compounded by advanced age and chronic comorbid conditions, leading to greater organ dysfunction and resource utilization. Early risk stratification and tailored management strategies may improve outcomes in non-trauma surgical ICU populations.

LIMITATIONS OF THE STUDY

1.             The study was conducted at a single tertiary care center, which may limit generalizability to other healthcare settings.

2.             The sample size of 100 patients may not have been sufficient to detect small but clinically meaningful differences in mortality.

3.             The cross-sectional design limits the ability to establish causal relationships between risk factors and outcomes.

4.             Long-term outcomes after ICU discharge were not assessed.

5.             Potential confounding factors such as severity of primary surgical illness, antimicrobial resistance patterns, and timing of intervention were not evaluated in detail.