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Early Predictors of Postinjury Multiple Organ Failure

Early Predictors of Postinjury Multiple Organ Failure Abstract Objective: To find a predictive model for postinjury multiple organ failure (MOF). Design: A 3-year cohort study ending December 1992 (first year: retrospective; last 2 years: prospective). Setting: Denver General Hospital (Colo) is a regional level I trauma center. Patients: Consecutive trauma patients with an Injury Severity Score (ISS) greater than 15, with an age greater than 16 years, and who survived longer than 24 hours. Stepwise logistic regression analysis was performed in all patients (n=394), in the subgroup of patients with 0 to 12 hours, plus 12 to 24 hours base deficit (BD) results (n=220), and in a second subgroup of patients with BD plus lactate results at 0 to 12 hours and 12 to 24 hours (n=106). Main Outcome: Postinjury MOF. Results: The following variables were identified as independent predictors of MOF in the analysis of all patients: age more than 55 years, ISS greater than or equal to 25, and more than 6 U of red blood cells in the first 12 hours after admission (U RBC/12 hours). In the subgroup with BD results, the same analysis identified age greater than 55 years, greater than 6 U RBC/12 hours, and BD greater than 8 mEq/L (0 to 12 hours), while in the last subgroup analysis including BD and lactate results, greater than 6 U RBC/12 hours, BD greater than 8 mEq/L (0 to 12 hours), and lactate greater than 2.5 mmol/L (12 to 24 hours) were independently associated with MOF. Conclusions: Age greater than 55 years, ISS greater than or equal to 25, and greater than 6 U RBC/12 hours are early independent predictors of MOF. Subgroup analyses indicate that BD and lactate levels may add substantial predictive value. Moreover, these results emphasize the predominant role of the initial insult in the pathogenesis of postinjury MOF.(Arch Surg. 1994;129:39-45) References 1. Baue AE. The horror autotoxicus and multiple organ failure . Arch Surg . 1992; 127:1431-1462.Crossref 2. Deitch EA. Multiple organ failure: pathophysiology and potential future therapy . Ann Surg . 1992:216:117-134.Crossref 3. Eiseman B, Beart R, Norton L. Multiple organ failure . Surg Gynecol Obstet . 1977;144:323-326. 4. Fry DE, Pearlstein L, Fulton RL, Polk HC Jr. Multiple system organ failure: the role of uncontrolled infection . Arch Surg . 1980;115:136-140.Crossref 5. Faist E, Baue AE, Dittmer H, Heberer G. Multiple organ failure in polytrauma patients . J Trauma . 1983;23:775-787.Crossref 6. Goris JA, Boekkorst TPA, Nuytinck JKS, Gimbrere JSF. Multiple-organ failure: generalized autodestructive inflammation? Arch Surg . 1985;120:1109-1115.Crossref 7. Waydhas C, Nast-Kolb D, Jochum M, et al. Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma . Arch Surg . 1991;127: 460-467.Crossref 8. Anderson BO, Poggetti RS, Shanley PF, et al. Primed neutrophils injure rat lung through a platelet activating factor dependent mechanism . J Surg Res . 1991; 50:510-514.Crossref 9. Koike K, Moore FA, Moore EE, Pogetti RS, Tudor RM, Banerjee A. Endotoxin after gut ischemia/reperfusion causes irreversible lung injury . J Surg Res . 1992; 52:656-660.Crossref 10. Tauber Al, Karnad AS, Hartshorn KL, et al. Parameters of neutrophil activation: models of priming and deactivation . Prog Clin Biol Res . 1989;297:298-309. 11. Worthen GC, Seccombe JF, Clay KL, et al. The priming of neutrophils by a lipopolysaccharide for production of intracellular platelet-activating factor: potential role in mediation of enhanced superoxide production . J Immunol . 1988; 140:3553-3559. 12. Read RA, Moore EE, Moore FA, Carl VS, Banerjee A. PAF induced PMN superoxide production does not require PMN-EC adhesion . Surgery . 1993;14: 308-313. 13. Moore FA, Haenel JB, Moore EE, Whitehill TA. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure . J Trauma . 1992;33:1-9.Crossref 14. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA. Pneumonia related multiple organ failure is not a primary cause of death in head trauma . Pan Am J Trauma . 1992;3:90-96. 15. Simel DL, Samsa GP, Matchar DB. Likelihood ratios for continuous test results: making the clinicians' job easier or harder? J Clin Epidemiol . 1993;46:85-93.Crossref 16. Moore FA, Moore EE, Rundus CH, Peterson VM. Inadequate granulocytopoiesis following major torso trauma: a hematopoietic regulatory paradox . Surgery . 1990;106:667-677. 17. Moore FA, Poggetti RS, Moore EE, Renick M, Bennet L. Postinjury cytokine response: a selective depression in G-CSF in the face of elevated IL-6 . Surg Forum XLI . 1990:107. 18. Moore FA, Moore EE, Poggetti RS, et al. Gut bacterial translocation via the portal vein: a clinical perspective in major torso trauma . J Trauma . 1991;31:629-639.Crossref 19. McAnena OJ, Moore FA, Moore EE, Mattox KL, Marx JA, Pepe P. Invalidation of the APACHE II scoring system for patients with acute trauma . J Trauma . 1992;33:504-507.Crossref 20. Civetta JM, Hudson-Civetta JA, Nelson LD. Evaluation of the APACHE II for cost containment and quality assurance . Ann Surg . 1990;212:266-276.Crossref 21. Flint LM. Sepsis and multiple organ failure . In: Moore EE, Mattox KL, Feliciano DV, eds. Trauma . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1988. 22. Siegel JH, Rivkind Al, Dalal S, Goodarzi SG. Early physiologic predictors of injury severity and death in blunt multiple trauma . Arch Surg . 1990;125:498-508.Crossref 23. Rutherford EJ, Morris JA, Reed GW, Hall KS. Base deficit stratifies mortality and determines therapy . J Trauma . 1992;33:417-423.Crossref 24. Champion HR, Sacco WJ, Copes WS. Trauma scoring . In: Moore EE, Mattox KL, Feliciano DV, eds. Trauma . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1988. 25. Nichols RL, Smith JW, Klein DB, et al. Risk of infection after penetrating abdominal trauma . N Engl J Med . 1984;311:1065-1070.Crossref 26. Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation . J Trauma . 1988:28:1464-1467.Crossref 27. Henao FJ, Daes JE, Dennis RJ. Risk factors for multiple organ failure: a casecomtrol study . J Trauma . 1991:31:74-80.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Early Predictors of Postinjury Multiple Organ Failure

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1994.01420250051006
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Abstract

Abstract Objective: To find a predictive model for postinjury multiple organ failure (MOF). Design: A 3-year cohort study ending December 1992 (first year: retrospective; last 2 years: prospective). Setting: Denver General Hospital (Colo) is a regional level I trauma center. Patients: Consecutive trauma patients with an Injury Severity Score (ISS) greater than 15, with an age greater than 16 years, and who survived longer than 24 hours. Stepwise logistic regression analysis was performed in all patients (n=394), in the subgroup of patients with 0 to 12 hours, plus 12 to 24 hours base deficit (BD) results (n=220), and in a second subgroup of patients with BD plus lactate results at 0 to 12 hours and 12 to 24 hours (n=106). Main Outcome: Postinjury MOF. Results: The following variables were identified as independent predictors of MOF in the analysis of all patients: age more than 55 years, ISS greater than or equal to 25, and more than 6 U of red blood cells in the first 12 hours after admission (U RBC/12 hours). In the subgroup with BD results, the same analysis identified age greater than 55 years, greater than 6 U RBC/12 hours, and BD greater than 8 mEq/L (0 to 12 hours), while in the last subgroup analysis including BD and lactate results, greater than 6 U RBC/12 hours, BD greater than 8 mEq/L (0 to 12 hours), and lactate greater than 2.5 mmol/L (12 to 24 hours) were independently associated with MOF. Conclusions: Age greater than 55 years, ISS greater than or equal to 25, and greater than 6 U RBC/12 hours are early independent predictors of MOF. Subgroup analyses indicate that BD and lactate levels may add substantial predictive value. Moreover, these results emphasize the predominant role of the initial insult in the pathogenesis of postinjury MOF.(Arch Surg. 1994;129:39-45) References 1. Baue AE. The horror autotoxicus and multiple organ failure . Arch Surg . 1992; 127:1431-1462.Crossref 2. Deitch EA. Multiple organ failure: pathophysiology and potential future therapy . Ann Surg . 1992:216:117-134.Crossref 3. Eiseman B, Beart R, Norton L. Multiple organ failure . Surg Gynecol Obstet . 1977;144:323-326. 4. Fry DE, Pearlstein L, Fulton RL, Polk HC Jr. Multiple system organ failure: the role of uncontrolled infection . Arch Surg . 1980;115:136-140.Crossref 5. Faist E, Baue AE, Dittmer H, Heberer G. Multiple organ failure in polytrauma patients . J Trauma . 1983;23:775-787.Crossref 6. Goris JA, Boekkorst TPA, Nuytinck JKS, Gimbrere JSF. Multiple-organ failure: generalized autodestructive inflammation? Arch Surg . 1985;120:1109-1115.Crossref 7. Waydhas C, Nast-Kolb D, Jochum M, et al. Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma . Arch Surg . 1991;127: 460-467.Crossref 8. Anderson BO, Poggetti RS, Shanley PF, et al. Primed neutrophils injure rat lung through a platelet activating factor dependent mechanism . J Surg Res . 1991; 50:510-514.Crossref 9. Koike K, Moore FA, Moore EE, Pogetti RS, Tudor RM, Banerjee A. Endotoxin after gut ischemia/reperfusion causes irreversible lung injury . J Surg Res . 1992; 52:656-660.Crossref 10. Tauber Al, Karnad AS, Hartshorn KL, et al. Parameters of neutrophil activation: models of priming and deactivation . Prog Clin Biol Res . 1989;297:298-309. 11. Worthen GC, Seccombe JF, Clay KL, et al. The priming of neutrophils by a lipopolysaccharide for production of intracellular platelet-activating factor: potential role in mediation of enhanced superoxide production . J Immunol . 1988; 140:3553-3559. 12. Read RA, Moore EE, Moore FA, Carl VS, Banerjee A. PAF induced PMN superoxide production does not require PMN-EC adhesion . Surgery . 1993;14: 308-313. 13. Moore FA, Haenel JB, Moore EE, Whitehill TA. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure . J Trauma . 1992;33:1-9.Crossref 14. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA. Pneumonia related multiple organ failure is not a primary cause of death in head trauma . Pan Am J Trauma . 1992;3:90-96. 15. Simel DL, Samsa GP, Matchar DB. Likelihood ratios for continuous test results: making the clinicians' job easier or harder? J Clin Epidemiol . 1993;46:85-93.Crossref 16. Moore FA, Moore EE, Rundus CH, Peterson VM. Inadequate granulocytopoiesis following major torso trauma: a hematopoietic regulatory paradox . Surgery . 1990;106:667-677. 17. Moore FA, Poggetti RS, Moore EE, Renick M, Bennet L. Postinjury cytokine response: a selective depression in G-CSF in the face of elevated IL-6 . Surg Forum XLI . 1990:107. 18. Moore FA, Moore EE, Poggetti RS, et al. Gut bacterial translocation via the portal vein: a clinical perspective in major torso trauma . J Trauma . 1991;31:629-639.Crossref 19. McAnena OJ, Moore FA, Moore EE, Mattox KL, Marx JA, Pepe P. Invalidation of the APACHE II scoring system for patients with acute trauma . J Trauma . 1992;33:504-507.Crossref 20. Civetta JM, Hudson-Civetta JA, Nelson LD. Evaluation of the APACHE II for cost containment and quality assurance . Ann Surg . 1990;212:266-276.Crossref 21. Flint LM. Sepsis and multiple organ failure . In: Moore EE, Mattox KL, Feliciano DV, eds. Trauma . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1988. 22. Siegel JH, Rivkind Al, Dalal S, Goodarzi SG. Early physiologic predictors of injury severity and death in blunt multiple trauma . Arch Surg . 1990;125:498-508.Crossref 23. Rutherford EJ, Morris JA, Reed GW, Hall KS. Base deficit stratifies mortality and determines therapy . J Trauma . 1992;33:417-423.Crossref 24. Champion HR, Sacco WJ, Copes WS. Trauma scoring . In: Moore EE, Mattox KL, Feliciano DV, eds. Trauma . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1988. 25. Nichols RL, Smith JW, Klein DB, et al. Risk of infection after penetrating abdominal trauma . N Engl J Med . 1984;311:1065-1070.Crossref 26. Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation . J Trauma . 1988:28:1464-1467.Crossref 27. Henao FJ, Daes JE, Dennis RJ. Risk factors for multiple organ failure: a casecomtrol study . J Trauma . 1991:31:74-80.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Jan 1, 1994

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