Risk factors for multiple organ system failure and death in critically injured patients.
BACKGROUND
This study was undertaken to evaluate the relative importance of factors related to the extent of multiple organ system failure (MOSF) and outcome in critical trauma.


METHODS
We performed a retrospective case series analysis of 206 consecutive patients with trauma admitted to a surgical intensive care unit during a 5-year period. Multivariate methods were used to select independent factors related to the MOSF score and subsequent death.


RESULTS
Multiple linear regression selected advancing age, prior chronic conditions, malnutrition, injury severity score (ISS), coma on admission, use of H2-receptor antagonists or antacids, number of blood transfusions, and intraabdominal infection as independent factors related to the MOSF score. Multiple logistic regression selected advancing age, chronic disease, ISS, and MOSF score as major predictors of death.


CONCLUSIONS
Advancing age, prior chronic disease, malnutrition, coma on admission, and use of H2-receptor antagonists or antacids may impair host defenses of the gastrointestinal tract and predispose to invasive infection, thereby aggravating the severity of existing MOSF. These findings, together with the predominance of Enterobacteriaceae in patients with infection, suggest that bacterial translocation may be important in the late MOSF septic state. Although infection, particularly intraabdominal infection, is a major risk factor for MOSF, a nonspecific host response to critical trauma, as expressed by the ISS and transfusion requirement, and intestinal endotoxin may contribute to the development of the syndrome.
Tran
D D
DD
Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.
Cuesta
M A
MA
van Leeuwen
P A
PA
Nauta
J J
JJ
Wesdorp
R I
RI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology; D004630:Emergencies; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*
D000863:Antacids; D006635:Histamine H2 Antagonists