Improvements in critical care decrease risk of post-injury multiple organ failure

05/12/05

CHICAGO Improvements in critical care and decreased use of blood transfusions over the course of the last decade are associated with decreases in the rate, severity and risk of death from post-injury multiple organ failure, according to a study in the May issue of Archives of Surgery, one of the JAMA/Archives journals.

Multiple organ failure (MOF) following injury is a leading cause of in-hospital death and is currently believed to be the result of uncontrolled, systemic inflammation, according to background information in the article. Age of the patient, severity of the injury and receiving a blood transfusion within 12 hours of injury have previously been identified as risk factors. Recent studies have suggested that the incidence and death rate from multiple organ failure has been decreasing due to advances in trauma and critical care.

David J. Ciesla, M.D., of the Denver Health Medical Center, and colleagues analyzed data on severely injured patients admitted to the Rocky Mountain Regional Trauma Center over the course of a 12-year period ending December 31, 2003, to determine whether the incidence and severity of multiple organ failure had decreased over the course of the last decade and to determine whether risk factors for multiple organ failure had changed over the course of the study. Multiple organ failure is based on evaluation of four organ systems, pulmonary, liver, kidney and cardiac. Single organ failure is defined by a dysfunction grade of one or greater on a scale of zero (best) to three (worse). Post-injury multiple organ failure is defined by a total score for the four organ systems of four or more within 48 hours after injury.

Of the 1,244 severely injured patients admitted over the 12-year period, 112 patients (eight percent) died. Of the 339 (25 percent) who developed multiple organ failure, 90 (27 percent) died. Over the course of the study there was a significant increase in the age of patients admitted and the severity of their injuries. At the same time, the number of blood transfusions and proportion of patients receiving more than six units of blood decreased significantly. Blood transfusion was recognized as a consistent early risk factor for multiple organ failure in 1997, prompting a more judicious use of blood transfusions.

After adjusting statistically for all risk factors, the authors were able to determine that there had been a significant decrease in the rate of multiple organ failure; multiple organ failure in 1992 was almost twice the rate observed in 2002. Further, the association between severity of injury and multiple organ failure became less strong in the second half of the study period, suggesting that the effect of injury severity on the development of multiple organ failure decreased over time, the authors report.

"The present study has confirmed that age, injury severity, and the use of blood transfusion during resuscitation are significant risk factors for postinjury MOF," the authors write. "We have found a decrease in the incidence of postinjury MOF among the most severely injured and an overall improvement in the indices of MOF severity over the last 12 years. Several other major advances in trauma and critical care also occurred over the last decade that may have influenced our results. Each of these advances has influenced our approach to trauma and critical care although the relative effect of any one advance on postinjury MOF outcome awaits further study. Nevertheless, our prospectively collected patient data indicate a substantial reduction in the incidence and severity of MOF following severe injury over the last decade."

(Arch Surg. 2005; 140:432-440. Available post-embargo at www.archsurg.com.)

Editor's Note: This study was supported by grants from the National Institutes of Health, Bethesda, Md., and the Jourdan Block Trauma Research and Development Foundation, Denver.

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