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. 2017 Apr;47(4):429-435.
doi: 10.1097/SHK.0000000000000779.

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Joanna M Shepherd  1 , Elaine Cole, Karim Brohi
Affiliations

Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Joanna M Shepherd et al. Shock. 2017 Apr.

Erratum in

Abstract

Background: Multiple organ dysfunction syndrome (MODS) is associated with poor outcomes for trauma patients. Different forms of MODS may exist and have different consequences. The ability to distinguish them clinically may have implications for prognosis and treatment. We wished to study whether prolonged MODS (PRMODS) could be observed as a distinct clinical entity to early resolving MODS (ERMODS) in critically injured patients.

Methods: Adult major trauma patients recruited to a prospective observational study at a single major trauma center were eligible for inclusion. MODS was defined as Sequential Organ Failure Assessment (SOFA) score >5; and PRMODS as lasting >7 days. Time to recovery (TTR) was calculated as the number of days before the SOFA fell below the MODS threshold (≤5).

Results: Five hundred ninety-five patients were enrolled of whom 285 developed ERMODS (48%) and 184 (31%) PRMODS. Organ dysfunction was more severe and protracted in PRMODS, especially in patients without brain injury (mean SOFA 11 vs. 6, Day 2, P < 0.001; TTR 17 vs. 3 days, P < 0.001). PRMODS exhibited higher rates of hepatic and renal dysfunction (84% vs. 56%; and 78% vs. 47%, P≤0.001). Patterns of recovery were distinct in hepatic, renal, and neurological systems (TTR 15 vs. 4; 20 vs. 3; and 28 vs. 7 days, P < 0.01). PRMODS was associated with higher infection and mortality rates (91% vs. 41%; and 22% vs. 7%, P < 0.001).

Conclusion: PRMODS appears common, a distinct clinical entity, and associated with worse patient outcomes. PRMODS may represent an important endpoint for studies evaluating outcomes following trauma.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Graphs (A) and (C) show mean SOFA scores by day of hospital admission for patients with no multiple organ dysfunction (No MODS), early resolving MODS (ERMODS), and prolonged MODS (PRMODS) in all patients (A) and in patients without traumatic brain injury (TBI) (C).
Fig. 2
Fig. 2
Mean component SOFA scores [(A) respiratory, (B) hepatic, (C) neurological, (D) cardiovascular, (E) renal, and (F) coagulation] by day of hospital admission in patients without traumatic brain injury (TBI) for no multiple organ dysfunction (No MODS), early resolving MODS (ERMODS), and prolonged MODS (PRMODS).
Fig. 3
Fig. 3
Mean component SOFA scores [(A) respiratory, (B) hepatic, (C) neurological, (D) cardiovascular, (E) renal, and (F) coagulation] by day of hospital admission in patients with traumatic brain injury (TBI) for no multiple organ dysfunction (No MODS), early resolving MODS (ERMODS), and prolonged MODS (PRMODS).
See this image and copyright information in PMC

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