IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

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Microparticles from Patients with Multiple Organ Dysfunction Syndrome and Sepsis Support Coagulation through Multiple Mechanisms

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615753 ◽

2001 ◽

Vol 85 (05) ◽

pp. 810-820 ◽

Cited By ~ 164

Author(s):

Karin Joop ◽

René Berckmans ◽

Rienk Nieuwland ◽

Johanna Berkhout ◽

Fred Romijn ◽

...

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Plasma Concentrations ◽

Annexin V ◽

Multiple Organ ◽

Factor Xii ◽

Healthy Controls ◽

Multiple Organ Dysfunction ◽

Coagulation Activation

Summary Aim. We investigated the occurrence and thrombin generating mechanisms of circulating microparticles (MP) in patients with multiple organ dysfunction syndrome (MODS) and sepsis. Methods. MP, isolated from blood of patients (n = 9) and healthy controls (n = 14), were stained with cell-specific monoclonal antibodies (MoAbs) or anti-tissue factor (anti-TF) MoAb and annexin V, and analyzed by flow cytometry. To assess their thrombin-generating capacity, MP were reconstituted in normal plasma. The coagulation activation status in vivo was quantified by plasma prothrombin fragment F1+2- and thrombin-antithrombin (TAT) measurements. Results. Annexin V-positive MP in the patients originated predominantly from platelets (PMP), and to a lesser extent from erythrocytes, endothelial cells (EMP) and granulocytes (GMP). Compared to healthy controls, the numbers of annexin V-positive PMP and TF-exposing MP were decreased (p = <0.001 for both), EMP were decreased (E-selectin, p = 0.003) or found equal (CD144, p = 0.063), erythrocyte-derived MP were equal (p = 0.726), and GMP were increased (p = 0.008). GMP numbers correlated with plasma concentrations of elastase (r = 0.70, p = 0.036), but not with C-reactive-protein or interleukin-6 concentrations. Patient samples also contained reduced numbers of annexin V-negative PMP, and increased numbers of erythrocyte-derived MP and GMP (p = 0.005, p = 0.021 and p <0.001, respectively). Patient MP triggered thrombin formation, which was reduced compared to the healthy controls (p = 0.008) and strongly inhibited by an anti-factor XII MoAb (two patients), by anti-factor XI MoAb (eight patients) or by anti-TF MoAb (four patients). Concentrations of F1+2 and TAT were elevated (p = 0.005 and p = 0.001, respectively) and correlated inversely with the number of circulating MP (and r = –0.51, p = 0.013, and r = –0.65, p = 0.001, respectively) and their thrombin generation capacity (F1+2: r = –0.62, p = 0.013). Conclusions. In patients with MODS and sepsis relatively low numbers of MP are present that differ from controls in their cellular origin, numbers and coagulation activation mechanisms.

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Comparison of Sepsis-related Organ Failure Assessment (SOFA) score and CIS (cellular injury score) for scoring of severity for patients with multiple organ dysfunction syndrome (MODS)

Intensive Care Medicine ◽

10.1007/s001340000710 ◽

2000 ◽

Vol 26 (12) ◽

pp. 1786-1793 ◽

Cited By ~ 33

Author(s):

Shigeto Oda ◽

Hiroyuki Hirasawa ◽

Takao Sugai ◽

Hidetoshi Shiga ◽

Kazuya Nakanishi ◽

...

Keyword(s):

Organ Failure ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Multiple Organ ◽

Cellular Injury ◽

Multiple Organ Dysfunction ◽

Injury Score ◽

Failure Assessment

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Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury

Critical Care Medicine ◽

10.1097/ccm.0000000000005055 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Vijay Krishnamoorthy ◽

Nancy Temkin ◽

Jason Barber ◽

Brandon Foreman ◽

Jordan Komisarow ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Organ Dysfunction ◽

Functional Outcomes ◽

Multiple Organ ◽

Multiple Organ Dysfunction

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Clinical Profile and Outcome of Multiple Organ Dysfunction Syndrome (MODS) in a Tertiary Care Centre of Manipal, Karnataka

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/643 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3547-3552

Author(s):

Manthappa Marijayanth ◽

Ashok Horatti ◽

Varsha Tandure ◽

Suheil Dhanse

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Tertiary Care ◽

Ventilatory Support ◽

Multiple Organ ◽

Adult Patients ◽

Clinical Profile ◽

Care Hospital ◽

Multiple Organ Dysfunction

BACKGROUND To study the clinical profile and outcome of multiple organ dysfunction syndrome (MODS) in previously healthy adult patients and to assess the correlation between sequential organ failure assessment (SOFA) score at admission and mortality in these patients. METHODS This study was conducted at a tertiary care hospital attached to a medical college of south India. This was a prospective observational study. All adult patients presenting with multiple organ dysfunction syndrome between October 2010 and June 2012 were selected for the study. SOFA score was recorded for all the patients at the time of admission. Patients were followed up till the time of death or discharge. RESULTS In this study, majority of the cases were males and belonged to middle age group. Epidemic diseases such as scrub typhus and leptospirosis were the most common causes of MODS. Fever was the most common presenting symptom of MODS. Majority of patients recovered. Higher SOFA score at admission is associated with increased mortality, duration of hospital stay, requirement of ventilatory support, haemodialysis, and central venous access. CONCLUSIONS Infectious diseases are responsible for most cases of MODS. Higher SOFA score at admission is associated with increased morbidity and mortality. Majority of people recover with appropriate treatment. KEYWORDS MODS, Clinical Profile, SOFA Score, Outcome

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Comparison of Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II and IV (APACHE) Scoring System Validity as Mortality Predictors in ICU Patients with Multiple Organ Dysfunction Syndrome in Sepsis

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/204 ◽

2021 ◽

Vol 8 (16) ◽

pp. 1058-1063

Author(s):

Akshay Hiryur Manjunatha Swamy ◽

Girish Bandigowdanahalli Kumararadhya ◽

Srinivas Hebbal Thammaiah ◽

Nanda Karikere Siddagangaiah ◽

Shiva Kumar K.G

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Multiple Organ ◽

Apache Ii ◽

Multiple Organ Dysfunction ◽

Icu Patients ◽

Significant Difference ◽

The Mean ◽

Apache Iv

BACKGROUND Multiple organ dysfunction syndrome (MODS) has recently been considered as a defining syndrome of sepsis and is responsible for a high mortality rate among the patients in the intensive care units (ICUs). Prognostication of the ICU patients is an integral part of the management of the critically ill patients and many scoring systems, for that matter, have been devised and compared for their efficiency at predicting mortality. This study was conducted to evaluate and compare the validity of sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) and APACHE IV as mortality predictors in intensive care unit (ICU) patients suffering from MODS in sepsis. METHODS Hundred patients diagnosed with MODS in sepsis were carefully examined, followed by relevant laboratory investigations. The SOFA score was calculated daily, and the APACHE II and IV scores were calculated on the day of admission. The scores were further compared among the survivors and the non-survivors, followed by receiver operating characteristic (ROC) curve analysis of the SOFA D1, D2, and D3 and the APACHE II and IV scores to estimate their capability of mortality prediction. RESULTS The means of the APACHE II, IV and SOFA D1 were 16.57 ± 6.49, 71.91 ± 16.19 and 8.75 ± 2.20, respectively. There was a statistically significant difference in the mean APACHE II scores (14.23 ± 5.20 vs. 21.12 ± 6.38) and the mean APACHE IV scores (67.27 ± 13.21 vs. 80.91 ± 17.77) in the survivors and the nonsurvivors. A statistically significant difference was also evident in the mean ages of the survivors and the non-survivors (52.82 ± 14.67 years vs. 63.25 ± 16.98 years). The SOFA score was high among the non-survivors than the survivors right from day-1 (10.24 ± 2.08 vs. 7.98 ± 1.86) to day-20 (15.00 ± 0.00 vs. 3.14 ± 0.38). Furthermore, ROC analysis showed that the best discrimination was provided by SOFA D3 followed by the APACHE II and SOFA D1 scores, with APACHE IV score showing the least. CONCLUSIONS SOFA score on day 3 provides the best mortality prediction in patients with MODS in sepsis, as compared to APACHE II and IV scores. KEYWORDS SOFA, APACHE II, APACHE IV, Multiple Organ Dysfunction Syndrome, Sepsis

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The potential of adipokines in identifying multiple trauma patients at risk of developing multiple organ dysfunction syndrome

European Journal of Medical Research ◽

10.1186/s40001-021-00511-z ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Julian Haupt ◽

Niels Krysiak ◽

Marina Unger ◽

Viktoria Bogner-Flatz ◽

Peter Biberthaler ◽

...

Keyword(s):

Multiple Trauma ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Plasma Concentrations ◽

Multiple Organ ◽

Control Group ◽

Trauma Patients ◽

Multiple Organ Dysfunction ◽

Patients At Risk ◽

Multiple Trauma Patients

Abstract Background Multiple organ dysfunction syndrome (MODS) and the consecutive multiple organ failure (MOF) are severe and dreaded complications with a high mortality in multiple trauma patients. The aim of this study was to investigate the potential of the adipokines leptin, resistin, interleukin-17A and interleukin-33 as possible biomarkers in the early posttraumatic inflammatory response and for identifying severely traumatized patients at risk of developing MODS. Methods In total, 14 multiple trauma patients with an injury severity score (ISS) ≥ 16 as well as a control group of 14 non-multiple trauma patients were included in this study and blood samples were taken at the time points 0, 6, 24, 48 and 72 h after admission. For the trauma patients, the SIRS and Denver MOF score were determined daily. The quantitative measurement of the plasma concentrations of the adipokines was performed using ELISA. Results In the statistical analysis, the multiple trauma patients showed statistically significant higher plasma concentrations of leptin, resistin, IL-17A and IL-33 compared to the control group. In addition, there was a statistically significant positive correlation between the concentrations of resistin, IL-17A and IL-33 and the corresponding SIRS scores and between the concentrations of resistin, IL-17A and IL-33 and the corresponding Denver MOF scores. Finally, ROC curve analysis revealed that the adipokines leptin and IL-17A are suitable diagnostic markers for the discrimination between multiple trauma patients with and without MOF. Conclusions Leptin and IL-17A could be suitable diagnostic markers to identify severely injured patients with a developing SIRS and MOF earlier, to adjust surgical therapy planning and intensive care.

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The Potential of Adipokines in Identifying Multiple Trauma Patients at Risk of Developing Multiple Organ Dysfunction Syndrome

10.21203/rs.3.rs-92157/v1 ◽

2020 ◽

Author(s):

Julian Haupt ◽

Niels Krysiak ◽

Marina Unger ◽

Viktoria Bogner-Flatz ◽

Peter Biberthaler ◽

...

Keyword(s):

Multiple Trauma ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Plasma Concentrations ◽

Multiple Organ ◽

Control Group ◽

Trauma Patients ◽

Multiple Organ Dysfunction ◽

Patients At Risk ◽

Multiple Trauma Patients

Abstract BackgroundMultiple organ dysfunction syndrome (MODS) and the consecutive multiple organ failure (MOF) are severe and dreaded complications with a high mortality in multiple trauma patients. The aim of this study was to investigate the potential of the adipokines leptin, resistin, interleukin-17A and interleukin-33 as possible biomarkers in the early posttraumatic inflammatory response and for identifying severely traumatized patients at risk of developing MODS.MethodsIn total, 14 multiple trauma patients with an injury severity score (ISS) ³ 16 as well as a control group of 14 non-multiple trauma patients were included in this study and blood samples were taken at the time points 0, 6, 24, 48 and 72h after admission. For the trauma patients, the SIRS and Denver MOF score were determined daily. The quantitative measurement of the plasma concentrations of the adipokines was performed using ELISA. ResultsIn the statistical analysis, the multiple trauma patients showed statistically significant higher plasma concentrations of leptin, resistin, IL-17A and IL-33 compared to the control group. In addition, there was a statistically significant positive correlation between the concentrations of resistin, IL-17A and IL-33 and the corresponding SIRS scores and between the concentrations of resistin, IL-17A and IL-33 and the corresponding Denver MOF scores. Finally, ROC curve analysis revealed that the adipokines leptin and IL-17A are suitable diagnostic markers for the discrimination between multiple trauma patients with and without MOF. ConclusionsThe results of this study may contribute to identify severely injured patients with a developing SIRS and MOF earlier, in order to adjust therapy strategies.

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