Predicting multiple organ failure in patients with severe trauma

Abstract

Objective: Pathophysiological processes in the first days after trauma seem to be important for the development and final outcome in cases of multiple organ failure (MOF). Our objective in this study was to assess the kinetics of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10) and phospholipase A2 group II (PLA2-II) as predictors of more severe forms of MOF. As well, we sought to assess the criteria for systemic inflammatory response syndrome (SIRS) and Simplified Acute Physiology Score (SAPS II) values and to create predictive models of MOF development.

Methods: This prospective study recruited a sample from 75 patients treated for severe injuries at surgical intensive care units at the Clinical Center of Serbia. Of these patients, a total of 65 met the entry criteria, which included an Injury Severity Score >or= 18 (severe injury), age range 16-65 years, admission to the hospital within the first 24 hours after injury and survival longer then 48 hours. We excluded patients with primary injury to the central nervous system.

Results: When patients with and without MOF were compared, a statistically significant difference was noted in the average CRP and PLA2II levels on all days. IL-6 and IL-10 concentrations were significantly different on all days of hospitalization.

Conclusion: According to the results of our study, it is possible to create predictive models with a high level of accuracy for the development of organ failure in traumatized patients. The most important parameters of MOF development are serum IL-6 concentration on the first day of hospitalization and the number of positive SIRS criteria on the fourth day of hospitalization.

Figures

FIG. 1. Time of multiple organ failure onset in patients with severe trauma.

FIG. 2. Number of positive SIRS variables per hospital days in patients with and without MOF. MOF = multiple organ failure; SIRS = systemic inflammatory response syndrome; white star = p < 0.05; black star = p < 0.01.

FIG. 3. Average CRP (mg/L), IL-6 (pg/mL), IL-10 (pg/mL) and PLA2-II (ng/L) in patients with and without MOF following severe trauma (Mann–Whitney U test). CRP = C-reactive protein; IL = interleukin; MOF = multiple organ failure; PLA2-II = phospholipase A2..