A 12-Year Prospective Study of Postinjury Multiple Organ Failure

Abstract

The incidence and severity of postinjury multiple organ failure (MOF) has decreased over the last decade. Design: A prospective 12-year inception cohort study ending December 31, 2003. Setting: Regional academic level I trauma center. Patients: One thousand three hundred forty-four trauma patients at risk for postinjury MOF. Inclusion criteria were aged older than 15 years, admission to the trauma intensive care unit, an Injury Severity Score higher than 15, and survival for more than 48 hours after injury. Isolated head injuries were excluded from this study. Previously identified risk factors for postinjury MOF were age, Injury Severity Score, and receiving a blood transfusion within 12 hours of injury. Main Outcome Measures: Multiple organ failure was defined by a Denver MOF score of 4 or more for longer than 48 hours after injury. Multiple organ failure severity was defined by the maximum daily MOF score and the number of MOF free days within the first 28 postinjury days. Results: Multiple organ failure was diagnosed in 339 (25%) of 1244 patients. The mean age and Injury Severity Scores increased and the use of blood transfusion during resuscitation decreased over the 12-year study period. After adjusting for age, injury severity, and amount of blood transfused during resuscitation, there was a decreased incidence of MOF over the study period. Of the patients who developed MOF, there was a decrease in disease severity and duration as measured by the maximum daily MOF score and the MOF free days. Although the overall mortality rate remained constant, the MOF-specific mortality decreased. Conclusions: The incidence, severity, and attendant mortality of postinjury MOF decreased over the last 12 years despite an increased MOF risk. Improvements in MOF outcomes can be attributed to improvements in trauma and critical care and are associated with decreased use of blood transfusion during resuscitation.

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

“…However, the overall incidence of MOF in trauma patients is higher than that of ARDS, ranging from 15% to 25%, which is three to five times higher than the ARDS incidence. [106][107][108][109] Assuming that the same ratio applies for the incidence in the transfused patients, an estimate of about 45-75% MOF would follow, with a simple average of 60%. However, the only trauma study retrieved on MOF, 109 which reported the transfusion rate, found this rate to be double (45.8%) that of the ARDS study by Chaiwat et al 105 (21%).…”

“…We estimated the probability of mortality in patients with ARDS from a trial in ARDS patients that reported a mortality rate of 83/385 = 21.6%. 111 We pooled data from two studies 106,107 to estimate the mortality rate in patients with MOF (Table 32): a 12-year prospective study of 339 patients with post-injury MOF, 106 and a prediction modelling study of 104 trauma patients of whom 21 developed MOF. 107 This yielded an overall MOF mortality rate of 26.2%.…”

Can Peripheral Blood Mononuclear Cells Be Used as a Proxy for Mitochondrial Dysfunction in Vital Organs During Hemorrhagic Shock and Resuscitation?

“…Multiple organ failure remains a significant cause of in-hospital morbidity and mortality following traumatic injury (2,19). Although the underlying cellular events leading to MOF are incompletely understood, impaired mitochondrial function and the depletion of cellular energy stores appear to play a central role (3–5).…”

Large-magnitude Pelvic and Retroperitoneal Tissue Damage Predicts Organ Failure

“…It is widely known that trauma is the leading cause of death for people younger than 45 years old [3]. For those who survive the initial traumatic insult, the most common cause of death is multiple organ failure (MOF) [6,13]. Although the incidence of MOF has slightly decreased over the last 15 years, MOF-related complications, intensive care unit (ICU) length of stay (LOS), and mortality have remained relatively constant [6,22].…”

“…For those who survive the initial traumatic insult, the most common cause of death is multiple organ failure (MOF) [6,13]. Although the incidence of MOF has slightly decreased over the last 15 years, MOF-related complications, intensive care unit (ICU) length of stay (LOS), and mortality have remained relatively constant [6,22]. Mechanical tissue damage, ischemic tissue injury (shock), preexisting host factors (age, comorbidities), and the host response all contribute to the development of MOF [24].…”