Postinjury multiple organ failure in polytrauma: more frequent and potentially less deadly with less crystalloid.
Multiple organ failure
Polytrauma
Resuscitation
Trauma
Trauma centre
Traumatic shock
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
04 Jan 2023
04 Jan 2023
Historique:
received:
11
08
2022
accepted:
17
12
2022
entrez:
4
1
2023
pubmed:
5
1
2023
medline:
5
1
2023
Statut:
aheadofprint
Résumé
Recently, retrospective registry-based studies have reported the decreasing incidence and increasing mortality of postinjury multiple organ failure (MOF). We aimed to describe the current epidemiology of MOF following the introduction of haemostatic resuscitation. A 10-year prospective cohort study was undertaken at a Level-1 Trauma Centre-based ending in December 2015. Inclusion criteria age ≥ 16 years, Injury Severity Score (ISS) > 15, Abbreviated Injury Scale (AIS) Head < 3 and survived > 48 h. Demographics, physiological and shock resuscitation parameters were collected. The primary outcome was MOF defined by a Denver Score > 3. intensive care unit length of stay (ICU LOS), ventilation days and mortality. Three hundred and forty-seven patients met inclusion criteria (age 48 ± 20; ISS 30 ± 11, 248 (71%) were males and 23 (6.6%) patients died. The 74 (21%) MOF patients (maximum Denver Score: 5.5 ± 1.8; Duration; 5.6 ± 5.8 days) had higher ISS (32 ± 11 versus 29 ± 11) and were older (54 ± 19 versus 46 ± 20 years) than non-MOF patients. Mean daily Denver scores adjusted for age, sex, MOF and ISS did not change over time. Crystalloid usage decreased over the 10-year period (p value < 0.01) and PRBC increased (p value < 0.01). Baseline cumulative incidence of MOF at 28 days was 9% and competing risk analyses showed that incidence of MOF increased over time (subdistribution hazard ratio 1.14, 95% CI 1.04 to 1.23, p value < 0.01). Mortality risk showed no temporal change. ICU LOS increased over time (subdistribution hazard ratio 0.95, 95% CI 0.92 to 0.98, p value < 0.01). Ventilator days increased over time (subdistribution hazard ratio 0.94, 95% CI 0.9 to 0.97, p value < 0.01). The epidemiology of MOF continues to evolve. Our prospective cohort suggests an ageing population with increasing incidence of MOF, particularly in males, with little changes in injury or shock parameters, who are being resuscitated with less crystalloids, stay longer on ICU without improvement in survival.
Sections du résumé
BACKGROUND
BACKGROUND
Recently, retrospective registry-based studies have reported the decreasing incidence and increasing mortality of postinjury multiple organ failure (MOF). We aimed to describe the current epidemiology of MOF following the introduction of haemostatic resuscitation.
METHODS
METHODS
A 10-year prospective cohort study was undertaken at a Level-1 Trauma Centre-based ending in December 2015. Inclusion criteria age ≥ 16 years, Injury Severity Score (ISS) > 15, Abbreviated Injury Scale (AIS) Head < 3 and survived > 48 h. Demographics, physiological and shock resuscitation parameters were collected. The primary outcome was MOF defined by a Denver Score > 3.
SECONDARY OUTCOMES
RESULTS
intensive care unit length of stay (ICU LOS), ventilation days and mortality.
RESULTS
RESULTS
Three hundred and forty-seven patients met inclusion criteria (age 48 ± 20; ISS 30 ± 11, 248 (71%) were males and 23 (6.6%) patients died. The 74 (21%) MOF patients (maximum Denver Score: 5.5 ± 1.8; Duration; 5.6 ± 5.8 days) had higher ISS (32 ± 11 versus 29 ± 11) and were older (54 ± 19 versus 46 ± 20 years) than non-MOF patients. Mean daily Denver scores adjusted for age, sex, MOF and ISS did not change over time. Crystalloid usage decreased over the 10-year period (p value < 0.01) and PRBC increased (p value < 0.01). Baseline cumulative incidence of MOF at 28 days was 9% and competing risk analyses showed that incidence of MOF increased over time (subdistribution hazard ratio 1.14, 95% CI 1.04 to 1.23, p value < 0.01). Mortality risk showed no temporal change. ICU LOS increased over time (subdistribution hazard ratio 0.95, 95% CI 0.92 to 0.98, p value < 0.01). Ventilator days increased over time (subdistribution hazard ratio 0.94, 95% CI 0.9 to 0.97, p value < 0.01).
CONCLUSION
CONCLUSIONS
The epidemiology of MOF continues to evolve. Our prospective cohort suggests an ageing population with increasing incidence of MOF, particularly in males, with little changes in injury or shock parameters, who are being resuscitated with less crystalloids, stay longer on ICU without improvement in survival.
Identifiants
pubmed: 36598541
doi: 10.1007/s00068-022-02202-8
pii: 10.1007/s00068-022-02202-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Sauaia A, Moore EE, Johnson JL, Chin TL, Banerjee A, Sperry JL, et al. Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid and lethal AAST 2013 Plenary Paper. J Trauma Acute Care Surg. 2014;76(3):582–93. https://doi.org/10.1097/TA.0000000000000147 .
doi: 10.1097/TA.0000000000000147
Frohlich M, Lefering R, Probst C, Paffrath T, Schneider MM, Maegele M, et al. Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society. Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31, 154 patients from the Trauma Register DGU. J Trauma Acute Care Surg. 2014;76(4):921–8. https://doi.org/10.1097/TA.0000000000000199 .
doi: 10.1097/TA.0000000000000199
Dewar DC, Tarrant SM, King KL, Balogh ZJ. Changes in the epidemiology and prediction of multiple-organ failure after injury. J Trauma Acute Care Surg. 2013;74(3):774–9. https://doi.org/10.1097/TA.0b013e31827a6e69 .
doi: 10.1097/TA.0b013e31827a6e69
Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010;34(1):158–63. https://doi.org/10.1007/s00268-009-0266-1 .
doi: 10.1007/s00268-009-0266-1
Ulvik A, Kvale R, Wentzel-Larsen T, Flaatten H. Multiple organ failure after trauma affects even long-term survival and functional status. Crit Care. 2007;11(5):95–103. https://doi.org/10.1186/cc611 .
doi: 10.1186/cc611
Laudi S, Donaubauer B, Busch T, Kerner T, Bercker S, Bail H, et al. Low incidence of multiple organ failure after major trauma. Injury. 2007;38(9):1052–8. https://doi.org/10.1016/j.injury-2007.03.026 .
doi: 10.1016/j.injury-2007.03.026
Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM. Multiple organ failure in trauma patients. J Trauma. 2003;55(4):608–16. https://doi.org/10.1097/01.TA.0000092378.10660.D1 .
doi: 10.1097/01.TA.0000092378.10660.D1
Goris R, Boekhorst T, Nuytinck J, Gimbrere J. Multiple organ failure. Generalized autodestructive inflammation? Arch Surg. 1985;120(10):1109–15. https://doi.org/10.1001/archsurg.1985.01390340007001 .
doi: 10.1001/archsurg.1985.01390340007001
Lausevic Z, Lausevic M, Trbojevic-Stankovic J, Krstic S, Stojimirovic B. Predicting multiple organ failure in patients with severe trauma. Can J Surg. 2008;51(2):97–102.
Hutchings L, Watkinson P, Duncan Young J, Willet K. Defining multiple organ failure after major trauma: a comparison of the Denver, Sequential Organ Failure Assessment, and Marshall scoring system. J Trauma Acute Care Surg. 2017;82(3):534–41. https://doi.org/10.1097/TA.0000000000001328 .
doi: 10.1097/TA.0000000000001328
van Wessem KJP, Leenen LPH. Reduction in mortality of post injury multiple organ dysfunction syndrome: a shifting paradigm? A prospective population based cohort study. Shock. 2018;49(1):33–8. https://doi.org/10.1097/SHK.0000000000000938 .
doi: 10.1097/SHK.0000000000000938
Stensballe J, Henriksen HH, Johansson PI. Early haemorrhage control and management of trauma induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care. 2017;23(6):503–10. https://doi.org/10.1097/MCC.0000000000000466 .
doi: 10.1097/MCC.0000000000000466
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82. https://doi.org/10.1001/jama.2015.12 .
doi: 10.1001/jama.2015.12
Dewar DC, White A, Attia J, Tarrant SM, King KL, Balogh ZJ. Comparison of postinjury multiple-organ failure scoring systems: Denver versus sequential organ failure assessment. J Trauma Acute Care Surg. 2014;77(4):624–9. https://doi.org/10.1097/TA.0000000000000406 .
doi: 10.1097/TA.0000000000000406
Sauaia A, Moore EE, Johnson JL, Ciesla DJ, Biffl WL, Banerjee A. Validation of postinjury multiple organ failure scores. Shock. 2009;31(5):438–47. https://doi.org/10.1097/SHK.0b013e31818ba4c6 .
doi: 10.1097/SHK.0b013e31818ba4c6
NSW Institute of Trauma and Injury Management. Major Trauma in NSW 2014. Sydney: NSW, Agency for Clinical Innovation. Major Trauma in NSW, 2014. A Report from the NSW Trauma Registry. Accessed 20 Apr 2021
Ciesla DJ, Moore EE, Johnson JL, Sauaia A, Cothren CC, Moore JB, et al. Multiple organ dysfunction during resuscitation is not post injury multiple organ failure. Arch Surg. 2004;139(6):590–4. https://doi.org/10.1001/archsurg.139.6.590 .
doi: 10.1001/archsurg.139.6.590
Frohlich M, Wafaisade A, Mansuri A, Koenen P, Probst C, Maegele M, et al. Which score should be used for posttraumtatic multiple organ failure?—comparison of the MODS, Denver—and SOFA—Scores. Scand J Trauma Resusc Emerg Med. 2016;24:130. https://doi.org/10.1186/s13049-016-0321-5 .
doi: 10.1186/s13049-016-0321-5
Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. A 12-year prospective study of postinjury multiple organ failure. Has anything changed? Arch Surg. 2005;140(5):432–40. https://doi.org/10.1001/archsurg.140.5.432 .
doi: 10.1001/archsurg.140.5.432
Benns M, Carr B, Kallan MJ, Sims CA. Benchmarking the incidence of organ failure after injury at trauma centers and nontrauma centers in the United States. J Trauma Acute Care Surg. 2013;75(3):426–31. https://doi.org/10.1097/TA.0b013e31829cfa19 .
doi: 10.1097/TA.0b013e31829cfa19
Nast-Kolb D, Aufmkolk M, Rucholtz S, Obertacke U, Waydhas C. Multiple organ failure still a major cause of morbidity not mortality in blunt multiple trauma. J Trauma. 2001;51(5):835–42. https://doi.org/10.1097/00005373-200111000-00003 .
doi: 10.1097/00005373-200111000-00003
Minei JP, Cuschieri J, Sperry J, Moore EE, West MA, Harbrecht BG, et al. The changing pattern and implications of multiple organ failure (MOF) after blunt injury with hemorrhagic shock. Crit Care Med. 2012;40(4):1129–35. https://doi.org/10.1097/CCM.0b013e3182376e9f .
doi: 10.1097/CCM.0b013e3182376e9f
Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA, Lezotte DC. Early predictors of postinjury multiple organ failure. Arch Surg. 1994;129(1):39–45. https://doi.org/10.1001/archsurg.1994.01420250051006 .
doi: 10.1001/archsurg.1994.01420250051006
Cuschieri J, Bulger E, Schaeffer V, Sakr S, Nathens AB, Hennessy L, et al. Early evaluation in random plasma IL-6 after severe injury is associated with development of organ failure. Shock. 2010;34(4):346–51. https://doi.org/10.1097/SHK.0b013e3181d8e687 .
doi: 10.1097/SHK.0b013e3181d8e687
Aldrian S, Koenig F, Weninger P, Vecsei V, Nau T. Characteristics of polytrauma patients between 1992 and 2002: what is changing? Injury. 2007;38(9):1059–64. https://doi.org/10.1016/j.injury.2007.04.022 .
doi: 10.1016/j.injury.2007.04.022
Australian Bureau of Statistics, 3101.0 Australian Demographic Statistics, 2015. http://www.abs.gov.au/ausstats . Accessed 20 Aug 2021
Bohmer AB, Just KS, Lefering R, Paffrath T, Bouillon B, Joppich R, et al. Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases. Crit Care. 2014;18(4):R143. https://doi.org/10.1186/cc13976 .
doi: 10.1186/cc13976
Sisak K, Soeyland K, McLeod M, Jansen M, Enninghorst N, Martin A, et al. Massive transfusion in trauma: blood product ratios should be measured at 6 hours. ANZJSurg. 2012;82(3):161–7. https://doi.org/10.1111/j.1445-2197.2011.05967.x .
doi: 10.1111/j.1445-2197.2011.05967.x
Kasotakis G, Sideris A, Yang Y, de Moya M, Alam H, King DR, et al. The Inflammation and Host Response to Injury Investigators. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the glue grant database. J Trauma Acute Care Surg. 2013;74(5):1215–22. https://doi.org/10.1097/TA.0b013e3182826e13 .
doi: 10.1097/TA.0b013e3182826e13
Sisak K, Dewar D, Butcher N, King K, Evans J, Miller M, et al. The treatment of traumatic shock: recent advances and unresolved questions. Eur J Trauma Emerg Surg. 2011;37(6):567–75. https://doi.org/10.1007/s00068-011-0150-1 .
doi: 10.1007/s00068-011-0150-1
Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for critical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80. https://doi.org/10.5603/AIT.2014.0060 .
doi: 10.5603/AIT.2014.0060