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A Physiologic Event or Sign of Sepsis?

Konstantinos G. Toutouzas, MD; George C. Velmahos, MD; Anna Kaminski, MS; Linda Chan, PhD; Demetrios Demetriades, MD, PhD

Arch Surg. 2002;137:924-929.

Hypothesis  Although elevations in white blood cell count (WBC) and platelet count (PC) after splenectomy for trauma constitute a physiologic event, certain WBC and PC patterns help differentiate patients with from those without sepsis.

Design  Medical record and trauma registry record retrospective review.

Setting  Academic level I trauma center.

Patients  From February 1997 through May 2001, 118 trauma patients underwent splenectomy. Sixty patients developed postoperative sepsis (pneumonia, abdominal infection, septicemia, or severe urinary tract infection) (septic group) and 58 did not (nonseptic group).

Main Outcome Measures  White blood cell count, PC, and PC/WBC.

Results  After the fifth postoperative day, the WBC of patients with sepsis remained consistently greater than 15 x 10³/µL and the PC/WBC remained consistently less than 20. In patients without sepsis, these values remained less than 15 x 10³/µL and greater than 20, respectively. Stepwise regression analysis identified 3 independent predictors of sepsis: (1) day 5 PC/WBC less than 20, (2) Injury Severity Score greater than 16, and (3) day 5 WBC greater than 15 x 10³/µL. According to a statistical prediction model, the probability of sepsis when all 3 predictors were present was 97.4%; when all 3 were absent, it was 2.5%.

Conclusions  At and after the fifth postoperative day, a WBC greater than 15 x 10³/µL and a PC/WBC less than 20 are highly associated with sepsis and should not be considered as part of the physiologic response to splenectomy. In view of the seriousness of postsplenectomy sepsis, these values may be used to increase vigilance and prompt early aggressive treatment.

From the Departments of Surgery, Division of Trauma and Critical Care (Drs Toutouzas, Velmahos, and Demetriades and Ms Kaminski), and Biostatistics (Dr Chan), University of Southern California, Keck School of Medicine, and the Los Angeles County and University of Southern California Medical Center, Los Angeles.

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