Early predictors of postinjury multiple organ failure.
OBJECTIVE
To find a predictive model for postinjury multiple organ failure (MOF).


METHODS
A 3-year cohort study ending December 1992 (first year: retrospective; last 2 years: prospective).


METHODS
Denver General Hospital (Colo) is a regional level I trauma center.


METHODS
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).


RESULTS
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.
Sauaia
A
A
Department of Surgery, Denver General Hospital, University of Colorado Health Sciences Center.
Moore
F A
FA
Moore
E E
EE
Haenel
J B
JB
Read
R A
RA
Lezotte
D C
DC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014947:Wounds and Injuries / Q000150:complications*