Refining the Pediatric Multiple Organ Dysfunction Syndrome

Since its introduction into the medical literature in the 1970s, the term multiple organ dysfunction syndrome (or some variant) has been applied broadly to any patient with >1 concurrent organ dysfunction. However, the epidemiology, mechanisms, time course, and outcomes among children with multiple organ dysfunction vary substantially. We posit that the term pediatric multiple organ dysfunction syndrome (or MODS) should be reserved for patients with a systemic pathologic state resulting from a common mechanism (or mechanisms) that affects numerous organ systems simultaneously. In contrast, children in whom organ injuries are attributable to distinct mechanisms should be considered to have additive organ system dysfunctions but not the syndrome of MODS. Although such differentiation may not always be possible with current scientific knowledge, we make the case for how attempts to differentiate multiple organ dysfunction from other states of additive organ dysfunctions can help to evolve clinical and research priorities in diagnosis, monitoring, and therapy from largely organ-specific to more holistic strategies.

Experience in treatment of patients with arterial and venous thrombosis with proven COVID-19

Background. COVID-19 is represented by a large number of different phenotypes, ranging from asymptomatic progress to the development of severe multiple organ dysfunction syndrome. The mechanisms of development of multiple organ dysfunction syndrome are multifactorial, including hypercoagulation with the formation of blood clots. They are often diagnosed as thrombotic complications with detection of blood clots not only in the veins and pulmonary arteries, but also in the heart and main arteries. An observational study shows that the incidence of venous and arterial thrombosis is as high as 31% in patients with COVID-19 pneumonia. However, large studies have not yet been conducted.Aim. To generalize and analyze our own observations of the clinical course of patients with thrombosis and COVID-19.Methods. The study included 5 male patients who had arterial and venous thrombosis and COVID-19 positive test. Results The experience of treatment of 5 patients with COVID-19 with arterial and venous thrombosis was analyzed. All patients showed characteristic changes in the coagulogram. The patient who, upon admission, had a negative test for COVID-19, and characteristic changes in the coagulogram appeared on the day of recurrent thrombosis, was of greatest interest. All patients received standard treatment and were discharged with improvement after testing negative for COVID-19.Conclusion. Generalization of the clinical course of patients with COVID-19 and thrombosis of various vascular regions allowed us to develop treatment tactics for these groups of patients.

Disseminated Human Parvovirus B19 Infection Induced Multiple Organ Dysfunction Syndrome in an Adult Patient With Alcoholic Hepatitis Complicated by Hemolytic Anemia: A Case Report and Literature Review

BackgroundHuman parvovirus B19 (B19) can cause acute hepatitis and is attributed to the high mortality of alcoholic hepatitis (AH). B19 infection is generally self-healing in previously healthy people, but it can cause fatal effects in some high-risk groups and increase its virulence and infectivity. Disseminated B19 infection-induced multiple organ dysfunction syndrome (MODS) in patients with AH has not been reported yet. Here, we described B19 viremia in an adult patient with AH accompanied by hemolytic anemia (HA), leading to disseminated infection and secondary MODS, as well as self-limiting B19 infections in seven nurses caring for him. Meanwhile, we reviewed the literature on AH and B19 infection.Case PresentationA 43-year-old male patient with AH accompanied by HA was transferred to the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, on March 31, 2021. After supportive treatment, his transaminase and bilirubin levels were reduced, but his anemia worsened. He received a red blood cell (RBC) infusion on April 9 for hemoglobin (Hb) lower than 6 g/dl. On April 13, he suddenly had a high fever. Under empirical anti-infection, his high fever dropped and maintained at a low fever level; however, his anemia worsened. On April 25, he was transferred to the medical intensive care unit (MICU) due to severe pneumonia, acute respiratory distress syndrome (ARDS), acute aplastic crisis (AAC), and hemophagocytic syndrome (HPS), which were subsequently confirmed to be related to B19 infection. After methylprednisolone, intravenous immunoglobulin (IVIG), empirical anti-infection, and supportive treatment, the lung infection improved, but hematopoietic and liver abnormalities aggravated, and systemic B19 infection occurred. Finally, the patient developed a refractory arrhythmia, heart failure, and shock and was referred to a local hospital by his family on May 8, 2021. Unfortunately, he died the next day. Fourteen days after he was transferred to MICU, seven nurses caring for him in his first two days in the MICU developed self-limiting erythema infectiosum (EI).ConclusionsB19 infection is self-limiting in healthy people, with low virulence and infectivity; however, in AH patients with HA, it can lead to fatal consequences and high contagion.

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

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

MULTIPLE ORGAN DYSFUNCTION SYNDROME IN ACUTE NECROTIZING PANCREATITIS

Acute necrotizing pancreatitis (ANP) is associated with significantlyhighermorbidity and mortality. It is still difficult for the surgeon to choose and schedule the most appropriate treatment.In the early phase of the disease, surgical activity is considered to be ineffective and is associated with high risks. The only chance to save the patient is to conduct the intensive therapy in the intensive care unit, based on current pathogenetic approaches. The present review analyzed the current understanding of the pathogenesis of multiple organ dysfunction syndrome (MODS) in acute necrotizing pancreatitis. The role of inflammatory mediators, cytokines, biogenic amines, bradykinins, and lipid peroxidation products in the development of organ hypoperfusion is reflected. It is shown that the violation of the intestinal barrier function with the translocation of microorganisms exacerbates endogenous intoxication and contributes to the development of MODS. The endothelial dysfunction that develops in acute necrotizing pancreatitis has a significant effect on hemostasis. The literature analysis revealed the contradictory data on the functional activity of the coagulation and anticoagulation systems at different stages of the disease. The mechanisms of development of intra-abdominal hypertension and its multisystem negative impact are reflected. There are still controversialquestionof appropriatetiming and indications for surgical decompression. The analysis of the available literature data showed the need for further study of the mechanisms of multiple organ dysfunction development in acute necrotizing pancreatitis to work out new pathogenetically justified methods of its intensive therapy with an assessment of their effectiveness.

IgM, IgA, IgG, and complement components as pre-operative markers for the development of multiple organ dysfunction syndrome in patients with infective endocarditis in early postoperative period

Aim. Here, we studied whether the immunoreactivity in pre-operative period defines early postoperative complications in patients with infective endocarditis (IE).Materials and Methods. We consecutively enrolled 110 patients with subacute IE (80 with native-valve IE and 30 with prosthetic valve IE) who underwent a heart valve replacement, then measuring the levels of IgM, IgA, IgG, and complement components in their serum and evaluating their correlation with an adverse early postoperative outcome.Results. Compared with patients< 50 years of age, those ≥ 50 years of age had 2-foldand 3-foldhigher prevalence of systemic inflammatory response syndrome and multiple organ dysfunction syndrome in the early postoperative period. Notably, these numbers correlated with increased С3d and С5а along with reduced Ig М and IgG. IgМ below 9.5 mg/mL and IgG below 2.0mg/mL indicated a 3-foldhigher risk of multiple organ dysfunction syndrome (OR = 3.07, 95% CI = 1.96-4.04, р=0,001).Conclusion. Serum IgM, IgG, and complements factors C3d and C5a may be used as prognostic markers of multiple organ dysfunction syndrome in the early postoperative period.

The Role of HSP70 in the Protective Effects of NVP-AUY922 on Multiple Organ Dysfunction Syndrome in Endotoxemic Rats

Sepsis is defined as a life-threatening organ dysfunction syndrome with high morbidity and mortality caused by bacterial infection. The major characteristics of sepsis are systemic inflammatory responses accompanied with elevated oxidative stress, leading to multiple organ dysfunction syndrome (MODS), and disseminated intravascular coagulation (DIC). As a molecular chaperon to repair unfolded proteins, heat shock protein 70 (HSP70) maintains cellular homeostasis and shows protective effects on inflammatory damage. HSP 90 inhibitors were reported to exert anti-inflammatory effects via activation of the heat shock factor-1 (HSF-1), leading to induction of HSP70. We evaluated the beneficial effect of HSP 90 inhibitor NVP-AUY 922 (NVP) on multiple organ dysfunction syndrome induced by lipopolysaccharide (LPS) and further explored the underlying mechanism. NVP (5 mg/kg, i.p.) was administered 20 h prior to LPS initiation (LPS 30 mg/kg, i.v. infusion for 4 h) in male Wistar rats. Results demonstrated that pretreatment with NVP significantly increased survival rate and prevented hypotension at 6 h after LPS injection. Plasma levels of ALT, CRE and LDH as well as IL-1β and TNF-α were significantly reduced by NVP at 6 h after LPS challenge. The induction of inducible NO synthase in the liver, lung and heart and NF-κB p-p65 and caspase 3 protein expression in the heart were also attenuated by NVP. In addition, NVP markedly induced HSP70 and HO-1 proteins in the liver, lung and heart after LPS injection. These results indicated that NVP possessed the anti-inflammatory and antioxidant effects on LPS-induced acute inflammation, which might be associated with HSP70 and HO-1, leading to prevent MODS in sepsis. NVP might be considered as a novel therapeutic strategy in the prevention of sepsis-induced MODS.