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Multiple organ dysfunction after trauma
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DOI：10.1002/bjs.11361.png)
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BackgroundThe nature of multiple organ dysfunction syndrome (MODS) after traumatic injury is evolving as resuscitation practices advance and more patients survive their injuries to reach critical care. The aim of this study was to characterize contemporary MODS subtypes in trauma critical care at a population level. MethodsAdult patients admitted to major trauma centre critical care units were enrolled in this 4-week point-prevalence study. MODS was defined by a daily total Sequential Organ Failure Assessment (SOFA) score of more than 5. Hierarchical clustering of SOFA scores over time was used to identify MODS subtypes. ResultsSome 440 patients were enrolled, of whom 245 (557 per cent) developed MODS. MODS carried a high mortality rate (220 per cent versus 05 per cent in those without MODS; P<0001) and 240 per cent of deaths occurred within the first 48h after injury. Three patterns of MODS were identified, all present on admission. Cluster 1 MODS resolved early with a median time to recovery of 4days and a mortality rate of 144 per cent. Cluster 2 had a delayed recovery (median 13days) and a mortality rate of 35 per cent. Cluster 3 had a prolonged recovery (median 25days) and high associated mortality rate of 46 per cent. Multivariable analysis revealed distinct clinical associations for each form of MODS; 24-hour crystalloid administration was associated strongly with cluster 1 (P = 0009), traumatic brain injury with cluster 2 (P = 0002) and admission shock severity with cluster 3 (P = 0003). ConclusionContemporary MODS has at least three distinct types based on patterns of severity and recovery. Further characterization of MODS subtypes and their underlying pathophysiology may lead to future opportunities for early stratification and targeted interventions.
Keyword:
PERSISTENT INFLAMMATION
FLUID RESUSCITATION
HEMORRHAGIC-SHOCK
BRAIN-INJURY
SOFA SCORE
FAILURE
DENVER
IMMUNOSUPPRESSION
EPIDEMIOLOGY
ASSOCIATION
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期刊
B
IF:
8.7
论文数:
2.0W
被引数:
2.5W
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