Changes in the epidemiology and prediction of multiple-organ failure after injury

Abstract

Background: The epidemiology of multiple-organ failure (MOF) after injury has been changing, questioning the validity of previously described prediction models. This study aimed to describe the current epidemiology of MOF. The secondary aim was development of a prediction model that could be used for early identification of patients at risk of MOF.

Methods: A 60-month prospective epidemiologic study was undertaken at an Australian Level I trauma center. Data were collected on trauma patients that met inclusion criteria (intensive care unit [ICU] admission; Injury Severity Score [ISS] > 15; age > 18 years, head Abbreviated Injury Scale [AIS] score < 3; and survival for >48 hours). Demographics, injury severity (ISS), physiologic parameters, MOF status based on the Denver score, and outcome data were prospectively collected. Univariate analysis and multivariate logistic modeling were performed; p < 0.05 was considered significant. Data are presented as percentage or mean (SD).

Results: A total of 140 patients met the inclusion criteria (age, 47 [21] years; ISS, 30 [11]; male, 69%), 21 patients (15%) developed MOF, and MOF associated mortality was 24% versus non-MOF mortality rate of 3%. Patients who developed MOF had longer ICU stays (19 [7] vs. 7 [5], p < 0.01) and had more ventilator days (18 [9] vs. 4 [4], p < 0.01). Prediction models were generated at two time points as follows: admission and 24 hours after injury. At admission, age (>65 years) and admission platelet count (<150 × 10(9)/L) were significant predictors of MOF; at 24 hours after injury, MOF was predicted by age more than 65 years, admission platelet count less than 150 × 10(9)/L, maximum creatinine of greater than 150 × 10(9)/L and minimum bilirubin of greater than 10 × 10(9)/L. Shock parameters and injury severity did not predict MOF.

Conclusion: The incidence of MOF (15%) is lower than reported 15 years ago; MOF remains a major cause of ICU resource use and late mortality after injury. The independent predictors of MOF have fundamentally changed, likely owing to improvements in resuscitation and critical care. Current predictors are universally available at admission and 24 hours.

Level of evidence: Epidemiologic/prognostic study, level III.