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

Abstract

The University Hospital Zurich together with IBM® invented an outcome prediction tool based on the IBM Watson technology, the Watson Trauma Pathway Explorer®. This tool is an artificial intelligence to predict three outcome scenarios in polytrauma patients: the Systemic Inflammatory Response Syndrome (SIRS) and sepsis within 21 days as well as death within 72 h. The knowledge of a patient’s future under standardized trauma treatment might be of utmost importance. Here, new time-related insights on the C-reactive protein (CRP) and sepsis are presented. Meanwhile, the validated IBM Watson Trauma Pathway Explorer® offers a time-related insight into the most frequent laboratory parameters. In total, 3653 patients were included in the databank used by the application, and ongoing admissions are constantly implemented. The patients were grouped according to sepsis, and the CRP was analyzed according to the point of time at which the value was acquired (1, 2, 3, 4, 6, 8, 12, 24, and 48 h and 3, 4, 5, 7, 10, 14, and 21 days). The differences were analyzed using the Mann–Whitney U-Test; binary logistic regression was used to determine the dependency of prediction, and the Closest Top-left Threshold Method presented time-specific thresholds at which CRP is predictive for sepsis. The data were considered as significant at p < 0.05, all analyses were performed in R. The differences in the CRP value of the non-sepsis and sepsis groups are starting to be significant between 6 and 8 h (p < 0.05) after admission inclusive of post hoc analysis, and the binary logistic regression depicts a similar picture. The level of significance is reached between 6 and 8 h (p < 0.05) after admission. The knowledge of the outcome reflected by the CRP in polytrauma patients improves the surgeon’s tactical position to indicate operations to reduce antigenic load and avoid an infectious adverse outcome.

IBM WATSON Trauma Pathway Explorer© as a Predictor for Sepsis after Polytrauma - Is Procalcitonin Useful for Identifying Septic Polytrauma Patients?

“…This study has shown similar results, with PCT values reaching their maximum after 24 hours. A previous study with the same polytrauma patient cohort at the University Hospital Zurich has shown that CRP is predictive for sepsis even earlier than PCT, 6-8 hours after admission to the hospital [32] However, in many studies, CRP had no ability for sepsis in trauma patients [8][9][10][11][12]28,30,[33][34][35]. Further investigations have to be conducted to compare the predictive values of PCT with other biomarkers such as IL-10.…”

The Role of Lactate for Sepsis in Polytrauma Patients, a Time related Analysis using the IBM Watson Trauma Pathway Explorer®

“…3653 patients were included for analysis in Watson Trauma Pathway Explorer, based on an ongoing database (2022) introduced on 01.08.1996. In both groups, lactate values were measured at formerly [5] defined time points (admission, 1, 2, 3, 4, 6, 8, 12, 24, and 48 h and 3, 4, 5, 7, 10, 14, and 21 days) after admission to the trauma bay of the University Hospital Zurich.…”

“…Accurate triaging plays a pivotal role in patient admission to the trauma bay. For such, various measured and calculated parameters are taken into account to estimate the risk of adverse events (AE) and mortality [1][2][3][4][5]. Recently, the University Hospital of Zurich and IBM collaborated for the construction of an artificial intelligence tool to predict the outcome [Systemic Inflammatory Respiratory Syndrome (SIRS) and sepsis within 21 days, and death within 72h] in polytrauma patients, based on a data sample of more than 3500 patients with ongoing admission [6,7].…”

“…The predictive tool is time-related and therefore useful for re-assessment after time periods of up to 21 day after admission. After a previous predictive analysis of the C-reactive protein for sepsis in polytrauma [5], the question arose whether lactate could play a similar role in the course of polytrauma. While lactate increase is commonly caused hypoperfusion [8], it can further indicate an underlying disease process state or adrenergic stress [9][10][11][12], e.g.…”

The Road to Sepsis in Geriatric Polytrauma Patients—Can We Forecast Sepsis in Trauma Patients?

“…To address this need, this study group collaborated with IBM to develop the IBM WATSON Trauma Pathway Explorer©, a visual analytics tool that predicts outcomes in severely injured individuals [ 4 , 5 , 6 , 7 , 8 ]. This validated and interactive tool utilizes clinical and laboratory values to predict various outcomes, including the occurrence of sepsis after a patient’s admission.…”