1446: THE IMPACT OF COVID-19 ON THE ASSOCIATION OF TRAUMA WITH SHORT-TERM MORTALITY IN SEPSIS

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Introduction: Sepsis is a major complication of trauma. Recent reports suggest increased trauma-related mortality and sepsis-related death during the COVID-19 pandemic. However, the prognostic impact of trauma in sepsis and the impact of the pandemic on this association are unknown. We examined the population-level prognostic impact of trauma in sepsis and whether it was affected by the pandemic. Methods: We used a statewide dataset to identify hospitalizations aged ≥18 years with sepsis in Texas during April 1-December 31 for each year of 2019-2020 (to align each year with the date of introduction of COVID-19-specific ICD-10 code [U07.1] in the United States), using “explicit” ICD-10 codes. Trauma (as the principal diagnosis) was defined by previously reported ICD-10 code-based taxonomy. Hospitalizations with COVID-19 were excluded. Hierarchical, mixed-effects logistic regression was used to estimate the association of trauma with short-term mortality (defined as in-hospital mortality or discharge to hospice) among sepsis hospitalizations, including an interaction term between the year of admission and trauma. Sensitivity analyses were performed on the subsets of ICU admissions, those with septic shock, and those mechanically ventilated. Results: There were 380,301 sepsis hospitalizations in 2019-2020, of which 2,291 (0.6%) were admitted for trauma. Compared to those without trauma, sepsis hospitalizations with trauma were older (aged ≥65 years 59.3% vs 47.6%), and less commonly female (42.1% vs 50.0%) and racial/ethnic minority (42.6% vs 49.1%) [p < 0.0001 for all comparisons]. Short-term mortality in sepsis hospitalizations with and without trauma was 27.3% vs 18.1%, respectively. Short-term mortality among those with trauma in 2019 and 2020 was 25.7% vs 28.9%, respectively. On adjusted analysis, trauma remained associated with higher short-term mortality in sepsis (adjusted odds ratio 1.31 [95% CI 1.11-1.56]) overall. However, there was no interaction between trauma and the year of admission among septic patients (p=0.400). The findings on sensitivity analyses were consistent with the primary model. Conclusions: Trauma is associated with 30% higher risk of short-term mortality among septic patients. However, the magnitude of this adverse prognostic association was not affected by the pandemic.

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