title: Reticuloendothelial system activity and organ failure in patients with multiple injuries.
abstract: OBJECTIVE
  Reticuloendothelial system function is altered in patients with multiple trauma and organ failure.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Surgical intensive care unit at a level I trauma center.
  
  
  METHODS
  Patients with multiple blunt trauma and injury severity scores greater than 20, with no referrals.
  
  
  METHODS
  Every second day reticuloendothelial system (RES) clearance capacity and liver blood flow were determined by administering labeled human albumin. Liver function was measured by enzymatic decay of indocyanine green, and levels of plasma tumor necrosis factor alpha were evaluated.
  
  
  RESULTS
  In nonsurviving patients with blunt trauma, RES function was altered and was associated with organ dysfunction and infectious complications. Of 61 patients, 42 survived and 19 did not. Sixteen patients (84%) died of multiple organ failure. Significantly elevated RES activity (colloid clearance rate) was present between day 5 and day 13 after trauma in nonsurvivors (0.86+/-0.16 [mean +/- SD] on day 7, P = .003) compared with survivors (0.48+/-0.08 on day 7) and 20 healthy volunteers (0.47+/-0.06); RES activity then decreased to subnormal levels in nonsurvivors. Tumor necrosis factor alpha plasma levels were elevated early after injury only in nonsurvivors (on day 1: nonsurvivors, 1.2+/-0.4 ng/mL [mean +/- SD]; survivors, 0.5+/-0.2 ng/mL; P = .02). Indocyanine green half-life values increased late after trauma, indicating late organ failure (on day 19: nonsurvivors, 111+/-29 minutes [mean +/- SD]; survivors, 12+/-4 minutes; P<.001).
  
  
  CONCLUSIONS
  Early after trauma, nonsurviving patients demonstrated increased proinflammatory cytokine levels, followed by a state of pathological hyperactivation of the reticuloendothelial system prior to death. These results indicate that the stationary host defense system is involved in the mechanisms causing organ failure after severe trauma.
authors: Department of Trauma Surgery, Hannover Medical School, Germany.
authors: H C
authors: HC
authors: Pape
authors: D
authors: D
authors: Remmers
authors: M
authors: M
authors: Grotz
authors: J
authors: J
authors: Kotzerke
authors: S
authors: S
authors: von Glinski
authors: M
authors: M
authors: van Griensven
authors: M
authors: M
authors: Dahlweid
authors: S
authors: S
authors: Sznidar
authors: H
authors: H
authors: Tscherne
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D012157:Mononuclear Phagocyte System / Q000503:physiopathology*; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology*; D009104:Multiple Trauma / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D011446:Prospective Studies