Multiple Organ Failure Syndrome Complicating Heparin-Induced Thrombocytopenia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3021-3021
Author(s):  
James N. Frame ◽  
Elaine A. Davis ◽  
Ying Wang ◽  
Mary S. Emmett ◽  
Ashna R. Malapur
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Valve Replacement ◽  
Major Bleeding ◽  
Multiple Organ ◽  
Gi Tract ◽  
Bleeding Events ◽  
Platelet Counts ◽  
Organ Failures ◽  
The Mean

Abstract Background: To date, multiple organ failure complicating HIT has been reviewed in a limited patient (pt.) numbers in the medical literature. Objectives: (1) To describe the clinical features of pts. with HIT who developed the failure of ≥ 2 organs termed multiple organ failure syndrome (MOFS); (2) to determine the prevalence/incidence of MOFS HIT in a cohort of CAMC HIT Registry/open heart surgery (OHS) pts. Design: Retrospective case series identified from an IRB-approved HIT Registry. Setting: Tertiary-care medical center. Patients: 19 patients ≥ 18 yrs who presented from 1.1.00 to 12.31.04 with HIT ± thrombo-embolic complications (TEC) confirmed by serological (HPF4 ELISA, GTI) or functional (HIPA) HIT assays during (n=18) or after (n=1) a recent hospitalization with UFH exposure. Mean age: 71 yrs. (range, 49–84); women: 47%. UFH exposure settings (n): CABG alone (6) or with valve replacement (4), valve replacement alone or RV repair (1 each), aortic dissection repair (1), embolectomy or SBO (2 each), Whipple procedure (1; non-CA), atrial fibrillation (1). Measurements: Classification of MOFS: failure of ≥ 2 organs [e.g., brain, GI tract, liver, kidney, heart, lung (due to PE)] as modifications of the methods of Lefering R. et al (2002) and the Society of Thoracic Surgeons National Adult Cardiac Surgery Database, Version 2.52.1; platelet counts, clinical outcomes. Results: The prevalence of MOFS in HIT Registry pts. was 4.7% (19/404). During this time, the incidence of MOFS complicating OHS HIT pts. in the total OHS pts. was 0.12% (13/11,018). HIT was first suspected a mean of 10d (range, 1–38) from initial UFH exposure and a mean of 4.7d (range, <1d-25) after UFH was D/C’d where overall platelet counts [mean, 74x109/L, (range, 22- to 125-)] showed a 66% decrease from baseline [mean, 218 x 109/L, range (95- to 498-)]. At this time, 12 (63%) pts. had thrombocytopenia alone, 7 (37%) pts. had both thrombocytopenia and TEC, and 13 (68%) pts. had a total 19 organ failures (OF).: 1 OF: 8 pts.; 2 OF’s: 4 pts.; and 3 OF’s: 1 pt. At the time HIT was first suspected, the kidney (47%) and brain (32%) were the most frequent sites of organ failure. After the time HIT was first suspected and diagnosed, 17 (89%) pts. had developed ≥ 1 additional new OF: 1 OF: 7 pts.; 2 OF’s: 5 pts.; 3 OF’s: 5 pts. The liver (39%), kidney (23%) and GI tract (19%) were the most frequent sites of new OF’s. The mean/median overall number of organ failures/pt. were 2.6/2.0 (range, 2 to 4). Direct thrombin inhibitor (DTI) therapy was initiated in 17 (90%) at a mean of 2.5d (SD: 4.0) (range, 0–13) from the date HIT was first suspected: lepirudin (9) or Argatroban (8); (2 were not treated due to family wishes or late recognition). Lepirudin was switched to Argatroban in 2 pts. due to worsening renal failure and Argatroban was switched to lepirudin in 2 pts. due to worsening liver failure. The mean length of DTI therapy was 8.8 d (range, 1–20). Compared with non-MOFS HIT Registry pts. (n=395), MOFS HIT pts. had more fatal outcomes [95% (18/19) vs. 11% (45/395); p = 3.2x 10−15], major bleeding events [26% (5/19) vs. 6.3% (25/395); p = 0.008], and amputations [11% (2/19) vs. 1.5% (6/395); p = 0.047]. Conclusions: Although uncommon, MOFS may be the initial manifestation of HIT and is associated with catastrophic outcomes. Compared to non-MOFS HIT pts., MOFS HIT pts. had an increased rate of fatal outcomes, major bleeding events, and rates of amputation. In a subset of HIT pts., MOFS hampered the delivery of utilized DTI’s. Our data also suggest the need for earlier HIT recognition and DTI interventions.

scholarly journals Blood platelets in the development of sepsis, septic shock and multiple organ failure syndrome

2021 ◽  
Vol 22 (6) ◽  
pp. 1085-1096 ◽  
Author(s):  
N. B. Serebryanaya ◽  
P. P. Yakutseni
Keyword(s):  
Septic Shock ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Myocardial Dysfunction ◽  
Blood Platelets ◽  
Clinical Manifestations ◽  
Multiple Organ ◽  
Patient Death ◽  
Platelet Counts

Participation of blood platelets in the development of sepsis is clearly illustrated by hemocoagulation disorders and frequently observed thrombocytopenia. In the patients with sepsis, thrombocytopenia develops rapidly, with minimal platelet counts registered on the fourth day of observation, after which the platelet counts usually rise. Continuous thrombocytopenia and absence of a relative increase in platelets are considered predictors of patient death. The mechanisms of thrombocytopenia developing in sepsis are quite diverse, but the processes in periphery are prevailing, e.g., the so-called “platelet consumption” which is determined by their activation, chemotaxis and isolation in the microvasculature. Recently, a mechanism has been identified for the accelerated removal of platelets with desialized surface glycoproteins from the circulation. Sialidases, also known as neuraminidases, are widely present in viruses and bacteria, and pharmacological inhibition of sialidases is able to withstand thrombocytopenia in the infectious process. The key role of platelets in the development of septic shock was revealed. Sequestration of platelets in the microvessels of the lungs and brain (manifesting as thrombocytopenia) is accompanied by rapid serotonin release, thus underlying the main clinical manifestations, e.g., decreased blood pressure, heart rate and increased capillary permeability. To counteract sharp release of this mediator, pharmacological attempts are made to inhibit the SERT transporter by means of selective serotonin reuptake inhibitors. Blood platelets are key participants in the pathogenesis of multiple organ failure syndromes, such as acute renal damage, acute respiratory distress syndrome, myocardial dysfunction, and sepsis-associated encephalopathy. To restore impaired vascular permeability in these conditions, in particular, sepsis-associated encephalopathy, a pharmacological S1P receptor mimetic is under study. The review specifies possible pathogenetically significant targets that can be used to perform pharmacological correction of conditions associated with sepsis and concomitant thrombocytopenia.

Profound Endothelial Damage Predicts Impending Organ Failure and Death in Sepsis

2015 ◽  
Vol 41 (01) ◽  
pp. 016-025 ◽  
Author(s):  
Maria Johansen ◽  
Pär Johansson ◽  
Sisse Ostrowski ◽  
Morten Bestle ◽  
Lars Hein ◽  
...  
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Endothelial Damage ◽  
Multiple Organ ◽  
Cox Models ◽  
Soluble Thrombomodulin ◽  
Risk Of Death ◽  
Organ Failures ◽  
Predicted Risk

Endothelial damage contributes to organ failure and mortality in sepsis, but the extent of the contribution remains poorly quantified. Here, we examine the association between biomarkers of superficial and profound endothelial damage (syndecan-1 and soluble thrombomodulin [sTM], respectively), organ failure, and death in sepsis. The data from a clinical trial, including critically ill patients predominantly suffering sepsis (Clinicaltrials.gov: NCT00271752) were studied. Syndecan-1 and sTM levels at the time of study enrollment were determined. The predictive ability of biomarker levels on death and organ failures during follow-up were assessed in Cox models adjusted for potential confounders including key organ dysfunction measures assessed at enrollment. Of the 1,103 included patients, 418 died. sTM levels at the time of enrollment independently predicted risk of death in adjusted models (hazard ratio [HR] [highest quartile > 14 ng/mL vs. lowest quartile < 7 ng/mL] 2.2 [95% confidence interval [CI]: 1.2–4.0], p = 0.02, respectively). Conversely, syndecan-1 levels failed to predict death (adjusted HR [> 240 vs. < 70 ng/mL] 1.0 [95% CI: 0.6–1.5], p = 0.67). sTM but not syndecan-1 levels at enrollment predicted risk of multiple organ failure during follow-up (HR [> 14 ng/mL vs. < 7 ng/mL] 3.5 [95% CI: 1.5–8.3], p = 0.005 and 2.0 [95% CI: 0.8–5.0], p = 0.1321, respectively). Profound damage to the endothelium independently predicts risk of multiple organ failure and death in septic patients. Our findings also suggest that the detrimental effect of profound endothelial damage on risk of death operates via mechanisms other than causing organ failures per se. Therefore, damage to the endothelium appears centrally involved in the pathogenesis of death in sepsis and could be a target for intervention.

scholarly journals РЕТРОСПЕКТИВНЫЙ АНАЛИЗ ПРИЧИН ЛЕТАЛЬНОСТИ У БОЛЬНЫХ С ТЯЖЕЛЫМ ТЕЧЕНИЕМ COVID-19

2021 ◽  
pp. 62-68
Author(s):  
S. SEREDA ◽  
S. DUBROV ◽  
M. DENYSIUK ◽  
O KOTLIAR ◽  
S. CHERNIAIEV ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Causes Of Death ◽  
Multiple Organ ◽  
Common Causes ◽  
The Mean

In Ukraine, more than 3.5 million cases of COVID-19 have been registered during the pandemic, and the death toll is almost 90,000. Ukraine is a leader in Europe in the growth of new cases of COVID-19 and mortality from this disease. The search for effective treatment regimens and new approaches to the management of patients with coronavirus disease in order to reduce the severity of coronavirus disease, reduce mortality, the number of complications and improve the rehabilitation period is very important nowadays. The aim of the work. To determine the main causes of mortality in patients with severe COVID-19 by analyzing the frequency and structure of complications in deceased patients. Materials and methods. The study conducted a retrospective analysis of 122 medical charts of deceased patients with COVID-19 who were hospitalized in a communal non-profit enterprise “Kyiv city clinical hospital №17” for the period from September 2020 to November 2021. Results and discussion. The overall mortality among patients with COVID-19 was 9.3%, in the intensive care unit (ICU) – 48.4%. The most common causes of death in patients with COVID-19 were: respiratory failure (RF) – 100% of cases, pulmonary embolism (PE) and acute heart failure (AHF) - about 60%. The average length of stay of patients in inpatient treatment was 11.67 ± 8.05 days, and in the intensive care unit – 7.94 ± 6.24 days. The mean age of patients hospitalized in the ICU was 63.5 ± 12.9 years and the mean age of patients who died was 71.2 ± 10.29 years. Prognostically significant criteria for lethal consequences were the presence of comorbidity: cardiovascular diseases- 92.3%, endocrine system diseases – 28.4%, nervous system diseases – 23.07%, kidney diseases – 9.6%, cancer – 9,6%, autoimmune conditions – 7.69%, varicose veins – 5.7%, respiratory system diseases – 5.7%. In patients with fatal outcome lymphopenia (84.6%) was observed in patients on admission to the ICU. Vasopressor and inotropic support was performed in 50 % of patients with COVID-19. In 25 % of those who died during long-term treatment and long-term respiratory support, there was the development of multiple organ failure, which in most cases was the point of no return. Conclusions. The most common causes of death were: respiratory failure, thrombosis, acute cardiovascular failure, sepsis and multiple organ failure. The main nature of the complications is common, but the cohort may be affected by different factors and the percentage of complications may differ in other hospitals.

scholarly journals Primary Injuries and Secondary Organ Failures in Trauma Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

Scientifica ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Sigrid Beitland ◽  
Ingrid Os ◽  
Kjetil Sunde
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Multiple Organ Failure ◽  
Replacement Therapy ◽  
Organ Failure ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Organ Failures

Background. Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) is a severe complication in trauma patients. The aim of the study was to assess primary traumatic injuries and secondary organ failures in severe posttraumatic AKI.Methods. Retrospective review of adult trauma patients admitted to the trauma centre at Oslo University Hospital Ullevål. Injury severity score (ISS) was used to assess the severity of primary injuries, and sequential organ failure assessment (SOFA) score was utilized to measure secondary organ failures.Results. Forty-two (8%) of 506 trauma patients admitted to intensive care unit developed AKI treated with CRRT, whereof 40 (95%) suffered blunt trauma mechanisms. Patients had extensive primary organ injuries with median (interquartile range) ISS 36 (27–49). The majority of the patients had respiratory (93% intubated) and cardiovascular (67% with inotropic and/or vasoactive medication) failure within 24 hours after admission. AKI was often part of multiple organ failure, most frequently respiratory and cardiovascular failure, affecting 33 (75%) and 30 (71%) of the patients, respectively.Conclusion. Trauma patients with AKI undergoing CRRT often had severe primary injuries due to blunt trauma. Most of them suffered from secondary multiple organ failure concomitant to AKI.

scholarly journals Clinical Features of Fatalities in Patients With COVID-19

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Ya-Jun Sun ◽  
Yi-Jin Feng ◽  
Jing Chen ◽  
Bo Li ◽  
Zhong-Cheng Luo ◽  
...  
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Chronic Diseases ◽  
Clinical Features ◽  
Causes Of Death ◽  
Clinical Information ◽  
Multiple Organ ◽  
The Novel ◽  
The Mean ◽  
Novel Coronavirus

ABSTRACT Objectives: The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19. Methods: We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020. Results: Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death. Conclusions: COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.

Clinical case of periostitis in pregnant women complicated by sepsis

2020 ◽  
pp. 61-63
Author(s):  
S. Sh. Kakvaeva ◽  
M. A. Magomedova ◽  
A. N. Dzhalilova
Keyword(s):  
Pregnant Woman ◽  
Multiple Organ Failure ◽  
Pregnant Women ◽  
Organ Failure ◽  
Clinical Case ◽  
Clinical Observation ◽  
Infectious Agent ◽  
Modern Medicine ◽  
Multiple Organ ◽  
Number Of Patients

One of the most serious problems of modern medicine is sepsis. The number of patients undergoing this complication is 20–30 million (WHO) annually and has no tendency to decrease. Sepsis is characterized by severe multiple organ failure due to a violation of the response of the macroorganism to an infectious agent. Moreover, it is dangerous with high mortality. Sepsis often develops in patients with immunodeficiency conditions, which primarily include pregnant women. The article presents a clinical observation of a case of periostitis in a pregnant woman complicated by a septic state.

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