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PubMed2006

Prognostic predictive values of serum cytochrome c, cytokines, and other laboratory measurements in acute encephalopathy with multiple organ failure.

AIMS: To evaluate the prognostic predictive values of cytochrome c, cytokines, and other laboratory measurements in serum collected during neurological onset in acute encephalopathy with multiple organ failure. METHODS: In addition to general laboratory examinations, the concentrations of cytochrome c (apoptosis marker) and cytokines (inflammatory markers) were measured in serum samples collected at the initial phase in 29 patients with acute encephalopathy. The obtained values were evaluated as predictors for the development of severe encephalopathy. RESULTS: Cytochrome c, tumour necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), soluble TNF-receptor 1 (sTNF-R1), and aspartate aminotransferase (AST) concentrations at the initial phase were high and correlated well with patient outcome. High concentrations of serum cytochrome c (>45 ng/ml), sTNF-R1 (>2000 pg/ml), AST (>58 IU/dl), IL-6 (>60 pg/ml), and TNF-alpha (>15 pg/ml) predicted an unfavourable prognosis (sequelae and death) at 93%, 79%, 82%, 77%, and 60%, respectively. The specificity of those markers was 100%, 89%, 83%, 100%, and 100%, respectively. CONCLUSIONS: Serum cytochrome c is the most sensitive and specific predictor for the development of severe encephalopathy at the initial phase. Results suggest that this marker might be used to guide decisions regarding the start of the initial treatment and further intensive care.

Acute Disease↗
PubMedDate not supplied

[Classification of acute dysfunctions of organs and systems in multiple organ failure syndrome].

A classification of acute dysfunctions of the vital organs and systems in cases with multiple organ failure is proposed. It is suggested to assess the function as satisfactory, compensatory sufficiency, decompensated insufficiency, or failure. Clinical laboratory criteria of such rating are offered. Experience gained in the use of this classification is presented.

Acute Disease↗
PubMed1995

Volumetric control of continuous haemodialysis in multiple organ failure.

A system for precise volumetric control of continuous haemodialysis and its use in providing renal replacement treatment in the intensive care unit to 10 children with multiple organ failure are described. The system, termed slow efficient dialysis, provided effective clearance of urea, creatinine, potassium, and phosphate. It provided precise control of the volume of ultrafiltrate removed in a prospective manner ('dial up' fluid balance) to reduce haemodynamic instability and fluid management problems. The ease of use of this system for intensive care nurses meant that the system ran without the assistance of a second intensive care or renal nurse.

Adolescent↗
PubMed1994

[Multiple organ failure syndrome in protracted tachycardia (based on 4 cases)].

The multiple organ dysfunction syndrome (MODS) is mainly caused by sepsis--community acquired or more frequently by nosocomial infections acquired on the intensive care unit. Further causes are intoxications, burns and multiple trauma. MODS worsens the prognosis of intensive care patients. We report on four cases of MODS developing outside hospital as a result of sustained tachycardia. Severity of MODS was apparently dependent on the duration of tachycardia and was rapidly reversible after termination of the tachycardia. Our observations show that sustained tachycardia may also cause MODS.

Aged↗
PubMed2000

Role of DIC in multiple organ failure.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a severe and complex coagulopathy resulting from excessive thrombin formation. Although there is a final common pathway, consumption coagulopathy and multiple organ failure (MOF), the early pathophysiology differs depending on the underlying disease. AIM: The aim of this study is to elucidate the pathophysiology of septic DIC, and also to assess logical diagnostic and therapeutic procedure. METHODS: Blood samples were collected from septic patients. Coagulant, fibrinolytic and vascular markers were analyzed. RESULTS AND CONCLUSION: Damaged vascular endothelial cells overproduce plasminogen activator inhibitor 1, which, with excess production of thrombin, leads to fibrnolysis-suppressive DIC and fibrin formation in the microvasculature. These changes characterize the septic coagulopathy, which is often complicated by MOF; however, a bleeding tendency is relatively rare. The platelet count and fibrinogen/fibrin degradation products are most useful for the diagnosis of septic DIC. However, since the specificity is not sufficient with these screening tests, other tests including molecular markers should be added. Since endothelial damage plays an important role in the pathophysiology in septic DIC, treatment should be focused not only on abnormal coagulopathy but also on vascular damage. Protease inhibitors and antithrombin III are both effective treatments for DIC. Although heparin is a standard drug for the treatment of DIC, the use of heparin is not recommended in case of septic DIC.

Disseminated Intravascular Coagulation↗
PubMed1988

[A review of post-operative multiple organ failure in peripheral arterial diseases].

Two-hundred- and-fifty-one patients of peripheral arterial diseases underwent 281 operations for past 11 years in our institute, and multiple organ failure (MOF) occurred in 10 patients (4.0%). These patients were reviewed and were compared with in other diseases. Survival rate was 50% and all the patients with 4 or more organ disorders died. Incidence and survival rate were not significantly different from operative time, blood loss and blood transfusion. Significant difference was observed between elective operation (3.0%) and emergent operation (20.0%). Compared with other diseases, MOF occurred more rarely in peripheral arterial diseases than in aortic aneurysms, but occurred 1.4 times of digestive diseases. While the gastro-intestinal bleeding as the initial failure organ occurred more frequently in peripheral arterial diseases than in other diseases, heart and respiratory failures were rare. MOF occurred after peripheral arterial intervention as well as other abdominal and thoracic surgery. To avoid MOF it is important to avoid MOF that the emergent surgery should be kept out and that general status, especially the grade of diabetes mellitus should be evaluated sufficiently.

Adult↗
PubMed1990

The effect of heparin on multiple organ failure and disseminated intravascular coagulation in a sepsis model.

In order to elucidate a possible role of hypercoagulability leading to disseminated intravascular coagulation (DIC) in the pathogenesis of multiple organ failure (MOF), unfractionated heparin and the related agents were administered to septic rabbits which manifest DIC and MOF. Administration of heparin resulted in prevention of thrombocytopenia, leukopenia and elevation of plasma bilirubin and creatinine. The morphological hepatic damage was also ameliorated by heparin. Similar favorable effects were obtained by the administration of low molecular weight heparin. Dextran sulfate prevented the hepatic damage to some extent without improvement on other parameters. No significant effect was observed by the administration of a synthetic thrombin inhibitor (MD805). These results indicate that the favorable effect of heparin is due to its anticoagulant property, especially anti-Xa activity. Thereby, it is concluded that the hypercoagulable state leading to DIC is a prerequisite for the occurrence of MOF in sepsis.

Animals↗
PubMed1994

Serum lipofuscin as a prognostic indicator of adult respiratory distress syndrome and multiple organ failure.

Toxic oxygen free radical damage is thought to play an important role in events such as trauma and sepsis, in which adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF) are the major causes of late death. Serum lipofuscin concentration has been proposed as an indicator of lipid peroxidation caused by toxic oxygen free radicals. Serum lipofuscin level was measured in 75 healthy controls and sequentially in 66 patients in the intensive care unit; the latter included 18 patients who had undergone elective major vascular surgery, 20 after repair of ruptured abdominal aortic aneurysm and 28 with severe blunt trauma. Fifteen of the 66 patients died within 2 days. Ten of the remaining 51 patients developed ARDS and/or MOF and 41 had an uncomplicated postoperative course. Serum lipofuscin concentration in controls showed a positive correlation with age. Compared with controls, all three patient groups had significantly increased lipofuscin concentrations during the first day after major vascular surgery, trauma or shock. In addition, the ten patients who subsequently developed ARDS and/or MOF showed significantly increased lipofuscin levels on day 1, compared with those in the 41 who had an uncomplicated clinical course. The concentration of serum lipofuscin, which may act as a simple and valuable measure of grading oxidative stress, is positively related to the incidence of subsequent ARDS and/or MOF in patients at risk of these syndromes.

Aged↗
PubMed1987

Critical illness polyneuropathy. A complication of sepsis and multiple organ failure.

Nineteen patients developed polyneuropathy complicating critical illness. They had been admitted to a critical care unit following intubation for cardiac or pulmonary disease and had developed sepsis and multiple organ failure. Approximately one month following intubation, failure to wean from the ventilator and limb weakness prompted neurological referral. Examination disclosed weakness and wasting of muscles and impaired tendon reflexes in most, but not all, patients. Electrophysiological studies in 17 patients revealed attenuated compound muscle and sensory nerve action potential amplitudes and widespread denervation on needle electromyography. Autopsy in 9 patients who died of their critical illness revealed widespread primary axonal degeneration of motor and sensory fibres, with extensive denervation atrophy of limb and respiratory muscles. Survivors recovered from the polyneuropathy three to six months following discharge. Seventeen of the patients were segregated by electrophysiological criteria into mild (8) and severe (9) polyneuropathy categories. An analysis of these two groups failed to reveal putative metabolic, drug, nutritional or toxic factors that might be responsible for the polyneuropathy. Our studies suggest that the mechanism may be a fundamental defect, still unknown, which causes dysfunction of all organ systems in this syndrome.

Adult↗
PubMedDate not supplied

[Extrarenal purification of blood in patients with multiple organ failure: results and prognostic criteria].

Acetate hemodialysis (HD) with an artificial kidney an continuous hemofiltration were used in the treatment of 49 patients with the multiple organ failure syndrome (MOFS) developing as a complication of aortocoronary and mammary-coronary shunting and heart valve replacement. MOFS involved failure of the function of 3.5 +/- 0.2 vital organs on average. Acute circulatory disorders were observed in 100% of patients, acute renal failure in 75.5%, and perioperative myocardial infarction in 34.7%. In 93.9% of patients HD and HF were combined with forced ventilation of the lungs, in 97.9% with catecholamine infusion, in 26.5% with assisted circulation, and in 57.1% with the Swan-Ganz monitoring of the central hemodynamics and of oxygen transporting function of circulation. Multiple-modality intensive care resulted in survival of 21 (42.8%) patients. The survival of patients with MOFS depended on the number of involved organs, method of extracorporeal detoxication, and monitoring of central hemodynamics and oxygen-transporting function of the blood. Acute renal failure, respiratory distress syndrome, and shock deteriorated the prognosis for patients with MOFS.

Acute Kidney Injury↗
PubMed1996

Jack A. Barney Resident Research Award winner. The inflammatory profile of interleukin-6, interleukin-8, and soluble intercellular adhesion molecule-1 in postinjury multiple organ failure.

BACKGROUND: Interleukin-6 (IL-6), interleukin-8 (IL-8), and adhesion molecules have been implicated as mediators in neutrophil (PMN) and endothelial cell (EC) interactions leading to postinjury multiple organ failure (MOF). Our hypothesis was that circulating levels of IL-6, IL-8, and soluble intercellular adhesion molecule-1 (sICAM-1) would discriminate patients at risk for postinjury MOF. METHODS: Serial plasma levels of IL-6, IL-8, and sICAM-1 were measured in 27 high-risk trauma patients. RESULTS: The IL-6 and IL-8 levels were significantly elevated in MOF patients compared with non-MOF patients at 12 and 36 hours postinjury. The IL-6 level was also elevated at 84 and 132 hours, and IL-8 at 84 hours. The sICAM-1 level did not become elevated in MOF patients until 132 hours postinjury. CONCLUSION: Interleukin-6 and IL-8 are elevated early after trauma and discriminate patients who will develop MOF. Late elevation of sICAM-1 likely results from PMN cytotoxicity leading to EC injury or inflammation.

Adult↗
PubMed2002

Neutrophil hypochlorous acid production is impaired in multiple organ failure patients with candidaemia; reversal with antifungal agents.

OBJECTIVE AND DESIGN: Neutrophil-derived hypochlorous acid (PMN-HOCL) is a potent bactericidal and fungicidal agent. Neutrophils from patients with multiple organ failure (MOF) have an altered ability to inhibit Candida albicans. Conversely antifungal agents are effective in decreasing mortality in MOF patients with fungaemia. We determined the effect on the rate of production of PMN-HOCL in a series of MOF patients with C. albicans fungaemia when antifungal agents are administered. SUBJECTS AND METHODS: Eleven patients with MOF were recruited. Four patients had culture-positive C. albicans fungaemia (group 1) and 7 patients with MOF but without C. albicans fungaemia acted as controls (group 2). HOCL assays were performed on peripheral blood PMN obtained from group 1 and group 2 patients. RESULTS: The maximum PMN-HOCL production rate for group 1 increased from 0.24 nmol/million PMN/min to 0.8 nmol/million PMN/min after treatment with antifungal agents (p < 0.01) (Mann-Whitney U test) whereas the PMN-HOCL kinetic (rate) curves for group 1 post-treatment and for group 2 were similar (student's-t-test). CONCLUSIONS: These findings suggest that antifungal treatment improve PMN-HOCL production in MOF patients with C. albicans fungaemia and may improve the effectiveness in eradicating the organism.

Aged↗
PubMed2000

Intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 are increased in the plasma of children with sepsis-induced multiple organ failure.

OBJECTIVES: To determine concentrations of circulating adhesion molecules endothelial (E)-selectin, intercellular adhesion molecule (ICAM)-1, and vascular cell adhesion molecule (VCAM)-1 in children with sepsis-induced multiple organ failure (MOF), and to determine associations among increased concentrations of these circulating adhesion molecules and important outcome measures. DESIGN: Prospective study. SETTING: University pediatric intensive care unit. PATIENTS: A total of 77 consecutive children with sepsis and 14 acutely ill children without sepsis. INTERVENTIONS: Plasma E-selectin, ICAM-1, and VCAM-1 concentrations and organ failure index (indicating number of failed organ systems) were determined in 77 children on days 1 and 3 of sepsis, and in 14 control children on pediatric intensive care unit day 1. Multivariate logistic regression analysis was used to determine associations between adhesion molecule concentrations and clinically relevant outcome measures. MEASUREMENTS AND RESULTS: Plasma concentrations of E-selectin, ICAM-1, and VCAM-1 were increased in children with sepsis vs. control on day 1 (p < .05). Plasma VCAM-1 (but not ICAM-1 or E-selectin) was increased in children with more than three organ failures vs. children with less than three organ failures (p < .05). Plasma ICAM-1 and VCAM-1 (but not E-selectin) concentrations independently predicted number of organs failed and development of more than three organ failures. Plasma ICAM-1 and VCAM-1 also predicted mortality and development of sequential (pulmonary/hepatic/renal) MOF (p < .05). CONCLUSIONS: The pronounced and persistent increase in plasma VCAM-1 and ICAM-1 that occurs in children with sepsis and persistent MOF may indicate a phenotypic change in endothelium toward a more proinflammatory state. Alternatively, the source for these adhesion molecules may be activated leukocytes and other cell types. Future studies are required to determine the role of ICAM-1 and VCAM-1 in the pathogenesis of sepsis-induced MOF.

Adolescent↗
PubMed2001

Pitfalls in gastrointestinal permeability measurement in ICU patients with multiple organ failure using differential sugar absorption.

OBJECTIVE: To assess whether gastrointestinal permeability (GIP) at intensive care unit (ICU) admission, measured by differential sugar absorption, is related to severity of disease and multiple organ failure (MOF). Post hoc, to analyse the relation between the urinary sugar recovery and renal function. DESIGN: Prospective observational cohort study. SETTING: Eighteen-bed general ICU of a teaching hospital. PATIENTS: Sixty-four ventilated patients admitted with MOF. INTERVENTIONS: GIP was assessed within 24 h using cellobiose (C), sucrose (S) and mannitol (M) absorption. MEASUREMENTS AND RESULTS: Severity of disease: APACHE II and III, SAPS II and MPM II systems. Organ failure: SOFA, MODS and Goris score. The median urinary recovery of C was 0.147% (range 0.004-2.145%), of S 0.249% (0.001-3.656%) and of M 10.7% (0.6-270%). In 16 patients, M recovery was over 100% of the oral dose. They received red blood cell transfusion (RBC). In the non-transfused, the median cellobiose/mannitol (CM) ratio was 0.015 (0.0004-0.550). CM ratio was not related to severity of disease and inversely related to the SOFA score ( r=-0.30, p=0.04). Post hoc regression analysis showed that recoveries of C, S and M were positively related to urinary volume. Recoveries of C and S, but not of M, were positively related to creatinine clearance. The CM ratio corrected for diuresis, but was inversely related to creatinine clearance. CONCLUSIONS: Differential C, S and M absorption testing is unreliable after RBC transfusion, since bank blood contains mannitol. The excretion of C and S, but not of M, is limited by renal dysfunction. Differential sugar absorption is not reliable to test GIP in MOF patients, since non-permeability related factors act as confounders.

APACHE↗