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Results for “Multiple Organ Failure”

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PubMed2000

[Changes of leukocyte rheologic characteristics and cell adhesion molecules in patients with multiple organ failure after severe trauma].

OBJECTIVE: To explore the changes of leukocyte rheologic characteristics and of cell adhesion molecule in patients with multiple organ failure (MOF) after severe trauma. METHODS: By using the erythrocyte deformability apparatus, platelet and thrombus adhesion dual-purpose apparatus and enzyme-linked immunosorbent assay (ELISA), We measured the leukocyte deformability (LD), leukocyte adhesion function (LAF), leukocyte CD18 expression, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule (sVCAM-1) concentration in 36 MOF patients, 31 trauma patients, and 35 to be controls. RESULTS: The leukocyte filtration index (LFI), leukocyte adhesion rate (LAR), leukocyte CD18 expression, and sICAM-1 and sVCAM-1 concentration were significantly higher in MOF patients than in controls and trauma patients (F = 68.45 - 116.20, q = 12.161 - 21.374, P < 0.00), and the changes of these indicators in MOF deaths were more obvious than those in MOF survivors (t = 6.920 - 11. 665, P < 0.00). The LFI and LAR in MOF patients were positively related to leukocyte CD18 expression, sICAM-1, and sVCAM-1 concentration (r = 0.691 - 0.844, P < 0.001); LFI was positively related to LAR (r = 0.711, P < 0.001). CONCLUSION: The abnormalities of leukocyte rheologic characteristics and CAMs might be closely related to the occurrence of MOF and the severity of pathologic changes.

Adult↗

PubMed1988

Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis.

Gut malnutrition in patients with persistent hypermetabolism is hypothesized to be an important factor in postseptic multiple organ failure syndrome (MOFS). The hypothesis was made that enteral nutrition (EN) started at the onset of hypermetabolism could reduce the incidence of MOFS. Sixty-six patients with persistent hypermetabolism 4 to 6 days after onset of sepsis were prospectively randomized to receive either parenteral nutrition (PN) or enteral nutrition (EN) at 1.5 gm protein/kg/day and 30 nonprotein calories/kg/day; the EN and TPN were of the same composition. There was no reduction in either the incidence of MOFS or mortality attributable to the route of nutrition administration. The PN group tended to have better visceral protein support; the EN group had more gut complications. When analyzed, the type of formula given did have an effect on the nutritional outcome but not on the mortality rate. A formula with a nonprotein-calorie-to-nitrogen ratio of 100:1 was associated with more nitrogen retention, higher levels of visceral proteins, and better gut tolerance. The route of nutrition administration does not seem to affect the incidence of postseptic MOFS or mortality when hypermetabolism is already present and when commercially available nutritional formulas are used. The relationships among the route of nutrition, the type of enteral formula, and the disease process of hypermetabolism and MOFS appear to be complex and require much more investigation before the role of the gut and enteral nutrition can be defined.

Energy Intake↗

PubMed1995

Platelet activation and interaction with leucocytes in patients with sepsis or multiple organ failure.

This study focuses on the role of platelet membrane glycoproteins and platelet-leucocyte adhesion in patients with sepsis and multiple organ failure (MOF). Specifically, the study raises the following issues: (1) the influence of sepsis and MOF on platelet activation as assessed by surface expression of platelet membrane glycoproteins GPIIb-IIIa and thrombospondin; and (2) the effect of sepsis and MOF on platelet adhesion to circulating leucocytes. In addition, platelet activation and platelet-leucocyte adhesion are evaluated according to clinical outcome. Forty-five patients with suspected sepsis or MOF were evaluated by intensive care scoring systems (APACHE II and Elebute) to assess severity of disease. Flow cytometric techniques were used to examine platelet membrane expression of various adhesion molecules on circulating platelets and the appearance of platelet specific antigen (CD41) on leucocytes as an index of platelet-leucocyte adhesion. The results were compared with severity of disease and according to outcome in patients. Twenty-eight patients of the total study population were septic and 17 were non-septic. Twenty-two of the 28 septic patients suffered from severe MOF (APACHE II > or = 20) whereas in six septic patients MOF was absent. Eleven of the non-septic group suffered from moderate MOF whereas in six, severe MOF was present. In septic patients fibrinogen receptor activity on platelets was significantly above normal values (P < 0.001). When MOF was present, thrombospondin surface expression on circulating platelets also increased significantly (P < 0.05). Concomitantly, platelet-leucocyte adhesion was increased in sepsis (P < 0.05) and decreased in patients with MOF (P < 0.05). Significant lower levels of circulating platelet-leucocyte aggregates occurred in non-survivors (P < 0.05). We conclude that sepsis is associated with increased surface expression of platelet adhesion molecules and an increased occurrence of circulating platelet-leucocyte aggregates. The decrease in circulating platelet-leucocyte peripheral sequestration. An increased platelet-leucocyte adhesion and sequestration might account for development of MOF in the course of sepsis.

Adolescent↗

PubMed1998

Phenotypical characterization of cells in the thoracic duct of patients with and without systemic inflammatory response syndrome and multiple organ failure.

The subset composition and recirculation properties of the migrating lymphocyte pool in humans is largely unknown. The present study was conducted in order to phenotypically characterize cells in human thoracic duct lymph of patients under non-inflammatory and inflammatory conditions. These data were compared with data from peripheral blood, with special emphasis on those cells homing to the gut. Thoracic duct lymph and peripheral blood contained comparable proportions of B and T lymphocytes and CD8+ cells. Thoracic duct lymph contained proportionally more CD4+ cells, more CD4+CD45RO+ that express alpha 4 beta 7 cells and more CD8+CD45RO+ that express alpha 4 beta 7, as compared to peripheral blood. These data suggest an equal recirculation rate of B and T lymphocytes; a more active recirculation of CD4+ cells compared to CD8+ cells; and a more active recirculation of memory cells to the gut as compared to other extra-lymphoid sites in patients under non-inflammatory conditions. Data were also obtained in patients with the system inflammatory response syndrome and multiple organ failure. Although it is generally assumed that granulocytes and monocytes do not recirculate, lymph of multiple organ failure patients contained significantly more granulocytes than monocytes, indicating that in severe generalized inflammatory states these cells re-enter the circulation through the thoracic duct. Furthermore, no increased activation of cells homing to the gut was found in these patients.

Aged↗

PubMed1993

Thermogenic response to total parenteral nutrition in depleted patients with multiple organ failure.

Nutrient-induced thermogenesis was studied in eight patients with severe nutritional depletion and multiple organ failure after abdominal surgery. Energy expenditure (EE) and RQ were recorded continuously over a period of 4 days. On each study day balanced total parenteral nutrition was administered during a period of approximately 16 h, followed by a period of low-energy glucose infusion. The total energy supply was in the order of 110% of the measured EE and the supply of glucose, fat and amino-acids was 2.6 +/- 0.4, 2.6 +/- 0.2 and 0.84 +/- 0.2 kJ x kg BW(-1) x h(-1) (mean +/- SD), respectively. The nutrient-induced thermogenesis, expressed as the rise in EE in percent of the energy content of the administered nutrients, was approximately 5%, which appears to be lower than previously observed in healthy individuals. A plateau in energy expenditure was reached after 6-8 h in response to parenteral nutrition. It is hypothesized that this plateau reflects the oxidative capacity and thus may be used as a guideline for nutritional therapy.

Journal Article↗

PubMed2001

[Long-term outcome after multiple organ failure following severe trauma].

OBJECTIVE: The aim of this follow-up study was to find out if severely injured patients with multiple organ failure (MOF) show any organotopic sequelae in the late course. Additionally the occupational rehabilitation result as well as the reasons for a poor occupational result were investigated. METHODS: A total of 50 MOF patients with an injury severity of 45.3 +/- 2.1 PTS points were followed up 4.9 +/- 0.3 years after trauma. In order to show any organotopic sequelae, patients were examined and laboratory tests for the function of the lungs (function test, Horovitz-quotient), liver (bilirubin, GOT, bleeding time), and kidnies (creatinine, urea) were performed. The functional (locomotion and neurological system) and occupational rehabilitation results as well as the reasons for a poor occupational result were analysed. RESULTS: The clinical examination as well the functional and laboratory tests showed mainly normal results but in in 25% of the patients a significantly decreased range of motion of the elbow, hip, knee and ankle joint was found. The "return to work rate" was 64%. Reasons for a poor occupational result were the severity of head injury, a decreased range of motion of the hip joint and general physical fitness. CONCLUSIONS: Severely injured patients who survive MOF during their intensive care treatment, show no sequelae of organ failure. The occupational rehabilitation results were excellent with a "return to work rate" of 64% which was dependent on the severity of head injury, a decreased range of motion of the hip joint and general physical fitness.

Adolescent↗

PubMedDate not supplied

Acute experimental pancreatitis--morphological evidence for the development of a multiple organ failure syndrome.

In order to evaluate the systemic lesions during acute pancreatitis (AP) we produced the disease in rats by ligation of the common biliopancreatic duct. The animals were killed at 4, 24, 48 hours and at 7 days. Serum values of amylase appear increased 24 hours after common biliopancreatic duct ligation, decreased after 48 hours and remain at a low range at 7 days. The pancreatic lesions were: interstitial oedema, pancreatic ducts dilatation, necrosis, hemorrhages and extensive fat necroses in the peripancreatic area, retroperitoneum and mesentery. We also found signs of systemic damage, suggestive for a multiple organ failure syndrome in the lung (hemorrhages, neutrophils accumulation, microthromboses), stomach (erosive and hemorrhagic gastritis) and mild kidney hemorrhages. Thus we succeed in producing a pathological picture similar to the multiple organ failure syndrome (MOFS) lesions in a rat model by a mechanism similar to human biliary AP. This model could be useful in therapeutic studies and in further research in the field of pathogenesis of MOFS during AP.

Acute Disease↗

PubMed2004

Cardiac troponin I levels are a risk factor for mortality and multiple organ failure in noncardiac critically ill patients and have an additive effect to the APACHE II score in outcome prediction.

Cardiac troponin I (cTnI) is a specific marker of myocardial damage used in the diagnosis of acute coronary syndrome (ACS). Recent studies have shown that cTnI levels can also be elevated in patients without ACS, such as in sepsis and trauma patients, and that this is associated with an adverse prognosis. We have evaluated the clinical implications and prognostic significance of serum cTnI levels in noncardiac critically ill patients in a prospective observational study in a general medical intensive care unit at a tertiary-level hospital. A total of 108 consecutive patients without ACS or other cardiac disease was enrolled. Serum cTnI levels were measured on admission using enzyme-linked immunoabsorbant assay kits. Clinical laboratory parameters and outcome were compared between patients with elevated and normal cTnI levels. The prognostic significance of cTnI levels and the Acute Physiology And Chronic Health Evaluation (APACHE) II score was also analyzed. Forty-nine patients (45%) had elevated cTnI levels and 59 (55%) had normal levels. Compared with patients with normal cTnI levels, patients with elevated levels had a higher incidence of new failure of two or more organs, had a lower left ventricular ejection fraction during admission, were more likely to be associated with bacteremia, and had a higher intensive care unit mortality; they also had a significantly shorter survival over a 180-day follow up, before and after stratification by the APACHE II score. Multiple organ failure was the leading cause of mortality in patients with elevated cTnI levels. By multivariate analysis, elevated cTnI levels, a high APACHE II score, and underlying cancer were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE II score plus elevated cTnI levels than in patients with a high APACHE II score or elevated cTnI levels alone. In conclusion, elevated serum cTnI levels is a risk factor for multiple organ failure and mortality in noncardiac critically ill patients, and the cTnI levels and APACHE II score have an additive effect in outcome prediction.

Aged↗

PubMedDate not supplied

[High-volume hemodiafiltration in the treatment of sepsis and multiple organ failure: 2 methods of the elimination of TNF-alpha].

Permanent hemodiafiltration (PHDF) as a method for treating patients with sepsis and multiple organ failure (MOF) corrects the severity of generalized inflammatory reaction, which is caused by hyperproduction of bioactive substances. Cytokines can be eliminated from circulation by 2 methods of kidney-replacing therapy: convection and adsorption on hemofilter membrane. Despite the slight adsorption clearance, our results indicate that experimental data not always correspond to the clinical situation. Pronounced cytokinemia persists in patients with sepsis and MOF during PHDF. In addition to correction of the main hemostasis parameters, kidney-replacing therapy eliminates an appreciable amount of TNF-alpha and other proinflammatory cytokines. Estimation of TNF-alpha balance indicates its good adsorption on the surface of hemodiafilter membrane.

Adult↗

PubMed2002

Green skin discoloration associated with multiple organ failure.

OBJECTIVE: To report intense green hyperpigmentation related to FD & C Blue No. 1. DESIGN: Retrospective case review. SETTING: Surgical intensive care unit. PATIENT: A 67-yr-old woman with unstable angina, electrocardiographic S-T segment elevation, and a left ventricle thrombus requiring emergent coronary revascularization surgery. INTERVENTIONS: Postoperative monitoring and treatment for multiple organ dysfunction that included small-bowel tube feeding and propofol sedation. MEASUREMENTS AND MAIN RESULTS: The patient developed an intense green skin color. CONCLUSION: Patients with multiple organ failure may be at risk for unusual pigmentation effects from tube feeding dyes.

Acute Kidney Injury↗

PubMed1997

Bacterial translocation in multiple organ failure: cause or epiphenomenon still unproven.

BACKGROUND: A body of evidence exists for the occurrence of bacterial translocation and its relationship to multiple organ failure (MOF). METHODS: Relevant articles on bacterial translocation (the phenomenon defined as the passage of microbes and endotoxin across the intestinal barrier) in patients prone to develop MOF and in representative animal studies were selected. To interpret and evaluate the evidence for bacterial translocation in current literature, the endpoints generally used are discussed. RESULTS: Fractional data from individual manuscripts were tabulated and assessed for statistical significance with chi 2 analysis. Various clinically relevant stimuli, postulated as important causative factors for the development of MOF, appeared to be interrelated and related to bacterial translocation itself. CONCLUSIONS: Convincing evidence exists that bacterial translocation can occur in humans during various disease processes. However, it remains to be determined whether a causal relationship between bacterial translocation and MOF exists. MOF is probably multifactorial and not uniform in origin; when evaluating translocation as a causative factor in the absence of an infective focus, the type of initiating event and the period of time after which MOF develops should be taken into account. The origin of early MOF is probably a non-bacterial, extensive, inflammatory response resulting in massive generalized endothelial cell activation. Late MOF may be caused primarily by bacterial translocation inducing an imbalance between proinflammatory and anti-inflammatory cytokines.

Animals↗

PubMed2002

The tyrosine kinase inhibitor tyrphostin AG 126 reduces the multiple organ failure induced by zymosan in the rat.

OBJECTIVE: To investigate the effects of tyrphostin AG 126, a tyrosine kinase inhibitor, on the multiple organ failure (MOF) caused by zymosan in the rat. DESIGN: Zymosan (500 mg/kg, suspended in saline solution, i.p.) causes an enhanced formation of reactive oxygen species, which contribute to the pathophysiology of MOF. After zymosan or saline administration, animals were monitored for 12 days. MEASUREMENTS AND RESULTS: Treatment of rats with tyrphostin AG 126 (10 mg/kg, 3 mg/kg or 1 mg/kg intraperitoneally, 1 h and 6 h after zymosan) attenuated the peritoneal exudation and the migration of polymorphonuclear cells caused by zymosan in a dose-dependent fashion. Tyrphostin AG 126 also attenuated the lung, liver, and intestinal injury (histology) as well as the increase in the levels of myeloperoxidase and malondialdehyde caused by zymosan in the lung, liver, and intestine. Immunohistochemical analysis for nitrotyrosine, poly (ADP-ribose) polymerase (PAR), iNOS, and COX-2 revealed a positive staining in lung, liver and intestine from zymosan-treated rats. The degree of staining for nitrotyrosine, PAR, iNOS, and COX-2 were markedly reduced in tissue sections obtained from zymosan-treated rats which had received tyrphostin AG 126. Furthermore, treatment of rats with tyrphostin AG 126 significantly reduced the production of peroxynitrite and of pro-inflammatory cytokines TNF-alpha and IL-1beta. CONCLUSIONS: This study provides the first evidence that the protein kinase inhibitor tyrphostin AG 126 attenuates the degree of MOF associated with zymosan-induced peritonitis in the rat.

Animals↗

PubMed1998

Multiple organ failure (MOF) after severe trauma--a sheep model.

OBJECTIVE: To perform a reproducible long-term (10 days) large animal model of multiple systems organ failure without necessity of a continuous stimulus. DESIGN: Adult female merino sheep submitted to a 5-day stimulation period followed by a 5-day observation period. Day 1: Hemorrhagic shock was combined with a traumatic surgical insult (reamed intramedullary femoral nailing), followed by serial administrations every 12 h for 5 days of a combination of endotoxin and zymosan activated plasma. Organ function was followed for 5 further days. RESULTS: Cardiac index increased significantly during the study (day 1: 491 +/- 8 mm Hg; day 10: 427 +/- 20, p < 0.05). Liver function was impaired and bilirubin levels increased significantly (day 1: 2.9 +/- 0.3 micromol/l; day 10: 7.2 +/- 0.9; p < 0.05). Creatinine clearance decreased initially (day 1: 54 +/- 7 ml/min), increased to a peak on day 2 (104 +/- 27), and then deteriorated again (day 10: 53 +/- 18). CONCLUSION: This new large animal model of trauma-induced MOF is reproducible and may be suitable for the study of new therapeutic approaches to therapy.

Albumins↗

PubMed2003

Multiple organ failure and outcome of critically ill patients with haematological malignancy.

BACKGROUND: The number of failing organs systems in ICU patients with haematological malignancy is associated with outcome. The objective of this study was to assess short and long-term survival in these patients with special reference to multiple organ failure reflected by the SOFA (Sequential Organ Failure Assessment) score. METHODS: Retrospective chart review of haematological patients admitted to the 10-bed intensive care unit (ICU) of a tertiary level academic teaching hospital from 1994 to 1998. Of 31 admitted patients with the diagnosis of haematological malignancy, the charts of 30 were available for analysis. RESULTS: Univariate logistic regression analysis of factors previously shown to influence survival revealed that only admission SOFA score and untreated status of haematological disease were significantly associated with survival (P < 0.05). ICU, 3-month and one-year survival rates were 57% (17/30), 23% (7/30) and 20% (6/30), respectively. If maximal SOFA score during the ICU stay was included in a multivariate model comprising treatment status and effect, admission day SOFA and APACHE II scores, mechanical ventilation, renal replacement therapy and neutropenia, the maximal SOFA score became the only independent variable. All patients with an admission SOFA score exceeding 11 died in hospital. Leave-one-out method revealed that admission SOFA scores and the status of haematological disease (untreated or not) correctly classified 83% (25 of 30) of patients to survivors or non-survivors. CONCLUSIONS: Multiple organ failure assessed as SOFA score on admission and status of disease were associated with outcome in critically ill patients with haematological malignancy.

APACHE↗

PubMed1982

Measurement of metabolism in multiple organ failure.

Despite the emphasis on surgical nutrition, clinical research and practice are usually based on gross estimation of caloric requirements and no specific knowledge of caloric balance. One reason for this is the difficulty of measuring O2 and CO2 exchange in critically ill patients. We designed a system for intensive care unit (ICU) bedside measurement of O2 consumption (VO2), CO2 production (VCO2), respiratory quotient (RQ), and indirect calorimetry (E). We measured these variables daily in 57 surgical ICU patients at risk for multiple organ failure. Measured VO2 and E varied widely (+/- 40%) from estimated values. Seventeen patients had a cumulative negative balance of at least 10,000 calories; 13 died. This caloric deficient was reversed by caloric intake in three of these patients; one died. Fifteen patients had positive caloric balance. Only four of these died, but the CO2 load produced by hypercaloric feeding created ventilator weaning problems in some patients. Ventilator weaning was facilitated by decreasing total calories and substituting fat for carbohydrate to reduce the RQ. The incidence of multiple organ failure was higher in patients with large caloric deficits, although cause and effect are not inferred. We conclude that respirometry and indirect calorimetry are helpful for management and essential for nutritional research.

Adult↗

PubMedDate not supplied

Gut-derived mediators of multiple organ failure: platelet-activating factor and interleukin-6.

Laboratory studies suggest that the postischaemic gut serves as a priming bed for circulating neutrophils that provoke multiple organ failure. Platelet-activating factor, generated by phospholipase A2, appears to be active in priming neutrophils in the gut. Interleukin-6 also appears to be elaborated by the postischaemic gut, but may be even more important in distant organs via promoting neutrophil-mediated organ dysfunction.

Animals↗

PubMed1993

The gastrointestinal tract. The "undrained abscess" of multiple organ failure.

OBJECTIVE: This study determined the association between proximal gastrointestinal (GI) colonization and the development of intensive care unit (ICU)-acquired infection and multiple organ failure (MOF) in a population of critically ill surgical patients. SUMMARY BACKGROUND DATA: ICU-acquired infection in association with progressive organ system dysfunction is an important cause of morbidity and mortality in critical surgical illness. Oropharyngeal and gastric colonization with the characteristic infecting species is common, but its association with ICU morbidity is poorly defined. METHODS: A prospective cohort study of 41 surgical ICU patients was undertaken. Specimens of gastric and upper small bowel fluid were obtained for quantitative culture; the severity of organ dysfunction was quantitated by a numeric score. RESULTS: One or more episodes of ICU-acquired infection developed in 33 patients and involved at least one organism concomitantly cultured from the upper GI tract in all but 3. The most common organisms causing ICU-acquired infection--Candida, Streptococcus faecalis, Pseudomonas, and coagulase-negative Staphylococci--were also the most common species colonizing the proximal GI tract. Gut colonization correlated with the development of invasive infection within 1 week of culture for Pseudomonas (90% vs. 13% in noncolonized patients, p < 0.0001) or Staphylococcus epidermidis (80% vs. 6%, p < 0.0001); a weaker association was seen for colonization with Candida. Infections associated with GI colonization included pneumonia (16 patients), wound infection (12 patients), urinary tract infection (11 patients), recurrent (tertiary) peritonitis (11 patients), and bacteremia (10 patients). ICU mortality was greater for patients colonized with Pseudomonas (70% vs. 26%, p = 0.03); organ dysfunction was most marked in patients colonized with one or more of the following: Candida, Pseudomonas, or S. epidermidis. CONCLUSIONS: The upper GI tract is an important reservoir of the organisms causing ICU-acquired infection. Pathologic GI colonization is associated with the development of MOF in the critically ill surgical patient.

Aged↗

PubMed2002

Adrenocortical function and multiple organ failure in severe sepsis.

BACKGROUND: Some patients with severe sepsis may have relative adrenocortical insufficiency, although not all studies confirm this finding. Corticosteroids play an important role in controlling excessive immune response, and they may reduce the severity of organ dysfunction in critical illness. In this prospective study, we investigated the incidence of adrenal insufficiency in severe sepsis and its relation to the development of multiple organ failure. METHODS: Forty-one patients meeting the criteria for severe sepsis were studied. A short ACTH stimulation test was carried out within 24 h of the diagnosis of sepsis. Peak serum cortisol level < 680 nmol/L and a rise of less than 260 nmol/L were used as the criteria for relative adrenocortical insufficiency. RESULTS: Relative adrenocortical insufficiency was detected in six patients. Duration of the ICU stay (P = 0.002) and mechanical ventilation (P = 0.024) were significantly longer in patients with impaired adrenal function. In the survivors, SOFA scores were significantly higher in patients with impaired adrenal function. The plasma ACTH levels were normal in most of the patients with relative adrenal insufficiency, whereas most patients with normal adrenal function had extremely low plasma ACTH levels. CONCLUSION: The ICU stay was longer and multiple organ failure more severe in patients with impaired adrenocortical function. There was a clear dissociation between ACTH and cortisol levels in AAR patients. This finding suggests that the integrity of the hypothalamic-pituitary-adrenal axis may be impaired in severe sepsis.

Adrenal Cortex↗