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PubMed1993

[Cortisol responses to rapid ACTH test in patients with multiple organ failure].

Cortisol concentrations are usually elevated in sepsis, during major surgery and in burns. Adrenocortical response to stress seems to be essential for survival. To investigate the endogenous adrenocortical response to multiple organ failure, rapid ACTH stimulation tests were used in 15 patients. Patients were divided to nonsurvival group and survival group. Patients in both groups appeared to have increased adrenocortical activity, because basal cortisol concentrations were above normal (non-survival group: 33.8 +/- 13.7 micrograms.dl-1, survival group: 19.1 +/- 3.8). There are no significant differences between the two groups. We could not find absolutely adrenal insufficient patient. Plasma cortisol concentrations increased significantly in patients of both groups following ACTH stimulation. We found poor response to ACTH in two patients in non-survival group with very high basal cortisol concentrations. But there is no significant difference of cortisol response between the two groups. We could not determine whether the high mortality is associated with poor response to ACTH or not.

Adrenal Cortex↗
PubMed2001

[Hemophagocytosis during multiple organ failure: M-CSF overproduction or viral reactivation?].

OBJECTIVE: This study was aimed to assess the potential role of M-CSF and viral reactivation in the genesis of haemophagocytosis during the multiple organ failure (MOF) syndrome. METHODS: Twenty-five patients (mean age: 60 +/- 16 years; Apache II: 23 +/- 5) sustaining MOF with an unexplained thrombocytopenia were studied. In each patient, a bone marrow aspirate, serum M-CSF concentration, and a virological examination (Herpes viruses) were obtained on admission. In addition, 20 patients (mean age: 57 +/- 15 years; Apache II: 24 +/- 7) with at least two organ failures but no thrombocytopenia constituted the control group. Circulating M-CSF levels and the frequency of virus reactivation were compared between groups. RESULTS: Haemophagocytosis was diagnosed in 11/25 patients (44%). No viral reactivation was found. Serum M-CSF concentrations were higher in the presence of haemophagocytosis (699 +/- 242 vs 438 +/- 157 IU.mL-1; p < 0.05). Ferritin levels were also increased in the presence of a macrophage activation (3,258 +/- 2,807 vs. 520 +/- 280 mg.L-1; p < 0.0001). In contrast, both circulating M-CSF and ferritin levels were similar between thrombocytopenic patients with no hemophagocytosis and controls. CONCLUSIONS: This study confirmed the high incidence of haemophagocytosis in critically ill patients sustaining MOF. In this setting, circulating M-CSF levels were markedly elevated, whereas no Herpes viruses reactivation was found.

Aged↗
PubMed1998

ICAM-1 upregulation in distant tissues after hepatic ischemia/reperfusion: a clue to the mechanism of multiple organ failure.

BACKGROUND/PURPOSE: Endothelial cell adhesion molecules (ECAMs) are felt to play an important role in ischemia/reperfusion (I/R) injury by causing adhesion of leukocytes to endothelial cells. It is possible that ECAMs play a role in multiple organ system failure. ICAM-1 is one of the adhesion molecules that has been shown to be upregulated in response to cytokines. This upregulation leads to leukocyte endothelial cell interaction (adhesion) and to neutrophil infiltration of the affected tissue. The purpose of our study was to measure ICAM-1 expression in the liver and other organs after hepatic ischemia/reperfusion (I/R). METHODS: A laparotomy was performed on 14 Sprague-Dawley rats; 45 minutes of occlusive ischemia to the left lateral lobe was followed by 5 hours of reperfusion. The rat was injected with I125-labeled ICAM-1 MAb and I131-labeled nonbinding MAb (to control for nonspecific accumulation of ICAM-1 MAb). Entire organs were harvested and accumulated activity was measured in each organ. ICAM-1 levels were expressed as percent injected dose per gram of tissue. Control animals underwent sham laparotomy. RESULTS: ICAM-1 was upregulated in the ischemic lobe of the liver, nonischemic lobe of the liver, heart, kidney, intestine, and pancreas. Up-regulation in the lung was not significant. Both the lung and liver had high constitutive levels of ICAM-1. CONCLUSIONS: These data show that (1) significant hepatic upregulation of ICAM-1 after hepatic ischemia/reperfusion and (2) significant ICAM-1 upregulation in other tissues (heart, kidney, and intestine) after hepatic ischemia/reperfusion. The ICAM-1 upregulation in distant organs is likely mediated by cytokines such as tumor necrosis factor (TNF). These data show that leukocyte endothelial cell interactions in distant organs may be mediated by hepatic ischemia/reperfusion. This is a possible explanation for how failure of one organ can lead to failure of others in multiple organ system failure.

Animals↗
PubMed2001

[A case of disseminated intravascular coagulopathy (DIC) and multiple organ failure (MOF) after ingestion of hydrochloric acid].

Ingestion of caustic materials causes systemic damages and requires treatment in an intensive care unit. This report presents a case of disseminated intravascular coagulopathy (DIC) and multiple organ failure after ingestion of hydrochloric acid in an attempted suicide. The patient was admitted to the emergency ward within 1 hr after ingestion of 60 ml of 35% hydrochloric acid. Initial blood examination suggested hemolysis without anemia or thrombocytopenia. Arterial blood gas analysis exhibited evident metabolic acidosis with hypoxia. Two hours after ingestion, severe hemolysis, anemia, thrombocytopenia emerged with abnormal results from clotting and fiblinolysis tests, and a diagnosis of DIC was made. Subsequently, conjugate deviation and severe bleeding diathesis appeared. No evidence for gastrointestinal bleeding and brain hemorrhage was obtained in our abdominal echography and brain computed tomography, respectively. In spite of vigorous suppurative therapy including transfusion of blood, fresh frozen plasma, and catecholamines, the patient expired 29 hrs after ingestion. Autopsy was not carried out. Rapid progressive DIC as an acute complication of acid ingestion must be born in mind.

Acidosis↗
PubMed2005

Relation of endotoxin, endotoxin binding proteins and macrophages to severe alcoholic liver injury and multiple organ failure.

Our retrospective analysis of 105 patients with alcoholic liver injury confirmed that patients with severe alcoholic hepatitis (SAH) showed severe hyperbilirubinemia, reduced hepatic biosynthetic capacity, and marked acute inflammatory reactions, and developed multiple organ failure (MOF). Multivariate analysis using the Cox proportional hazards model showed serum C-reactive protein and DIC as significant independent prognostic factors among SAH, LC+AH, and AH groups. Improved assay showed an increase of plasma endotoxin with the progression of alcoholic liver injury. In most survivors, plasma Et levels decreased in the recovery phase. Serum interleukin (IL)-6 and IL-8 levels in the acute phase were high in patients with AH and LC+AH, especially in non-survivors and in patients with SAH. In the recovery phase, these cytokine levels in survivors tended to decrease, but in non-survivors, IL-6 remained high, and IL-8 further increased. Serum levels of HDL and albumin, which are protective against endotoxicity by inhibiting endotoxin uptake and TNF production by macrophages, were decreased with the progression of alcoholic liver injury. Animal experiments supported that the increase in endotoxin-binding capacity of HDL and albumin may serve as a protective mechanism against endotoxin in chronic ethanol-loaded rats and that an addition of high-dose ethanol to these rats may lead to impaired binding and inactivation of endotoxin. Lipopolysaccharide-binding protein (LBP) which enhances endotoxin uptake and TNF production by macrophages, was generally increased in patients with alcoholic liver injury. This imbalance among endotoxin binding proteins in the blood may induce overproduction of cytokines by macrophages in patients with severe alcoholic liver injury. Our animal experiments further revealed that an additional administration of a high-dose ethanol to chronic alcohol-fed rats led to decrease of endotoxin clearance, increased extrahepatic accumulation of endotoxin and elevation of plasma TNF. The splenic macrophages and pulmonary alveolar macrophages are demonstrated to be important for endotoxin uptake, and excessive production of TNF in rats given large amounts of alcohol. An in vitro culture experiment in the presence of rat LBP suggested a role of these macrophages in excessive production of TNF-alpha. When the functions of various macrophages were compared in rats given alcohol, maximum TNF-alpha secretion was noted in alveolar macrophages, In conclusion, endotoxemia and its effects on extrahepatic macrophages may play key roles in the progression of severe alcoholic liver injury and MOF.

Animals↗
PubMed2005

Lack of effect of N-acetylcysteine treatment to ameliorate the progression of multiple organ failure.

OBJECTIVE: To investigate whether prolonged infusion of the oxygen free radical scavenger N-acetylcysteine (NAC) that is commenced immediately after admission to intensive care unit (ICU) could ameliorate the development or progression of multiple organ failure (MOF). METHODS: After receiving ethical committee approval, a prospective randomized, double-blind, placebo controlled study was performed in the Anesthesiology and Reanimation Intensive Care Unit, Hacettepe University Hospital, Ankara, Turkey between December 2002 and May 2003. Twenty-six patients were randomized to receive either NAC in 5% dextrose 40 mg/kg/day or the same volume of 5% dextrose both in 4 divided doses. Two patients were withdrawn due to ICU stay <24 hours. Treatment effect on organ function was assessed by the sequential organ failure assessment (SOFA) scores according to physiological parameters of respiratory, hematological, hepatic, cardiovascular, central nervous system (CNS) and renal system scores that were obtained on admission, then daily. Chi-square, Mann Whitney U tests were used for statistical analysis. RESULTS: There was no significant difference between the 2 groups in any of the 5 organ dysfunction parameters, total maximum SOFA, delta SOFA length of intensive care stay, days of mechanical ventilation and mortality. In the NAC treatment group, the maximum SOFA coagulation score was higher than the control group (p<0.05). CONCLUSION: N-acetylcysteine (40 mg/kg/day) that was commenced immediately after admission to ICU did not ameliorate the progression of MOF in this small cohort of patients. We believe routine prophylactic use of low-dose NAC in all critically ill patients does not provide positive protection.

Acetylcysteine↗
PubMed1983

[The role of multiple organ failure in DIC].

The records of 27 cases of disseminated intravascular coagulation with burn, trauma, perforated peritonitis or leakage of gastrointestinal anastomoses at the Second Department of Surgery and Intensive Care Unite, Toho University Hospital from 1977 to 1982 were reviewed. In this series, multiple organ failure (MOF) occurred in 20 cases and single organ failure occurred in 4 cases. Lung failure occurred in 20 out of 27 cases. Renal failure occurred in 18 out of 27 cases. Then, correlation was observed between decrease in platelet count and decrease in PaO2/FiO2. Serum creatinine level and total bilirubin level were elevated according to the progress of DIC. Twenty death cases with DIC out of 21 had MOF. However, 3 survived cases out of 6 cases had only single organ failure and other 3 survived cases out of 6 cases had not organ failure. Therefore, close correlation was observed between DIC and MOF in the prognosis of DIC. Earlier and active support of organ failure was important for clinical management of DIC.

Bilirubin↗
PubMed1992

Plasma lignocaine concentrations associated with extradural analgesia in patients with and without multiple organ failure.

We have measured plasma concentrations of lignocaine after thoracic extradural analgesia with continuous infusion of lignocaine in eight intensive care patients with chest wall trauma or after major upper abdominal surgery. Four patients developed multiple organ failure (MOF). Plasma concentrations of lignocaine in arterial blood were measured 4, 8, 24 and 48 h after a continuous infusion of lignocaine was commenced in the extradural space. Plasma concentrations of lignocaine were greater in all patients with MOF (range 2.7-5.1 micrograms ml-1) than in patients without MOF (range 0.8-1.2 micrograms ml-1). Because plasma concentrations in patients with MOF were within the low toxic range, extradural infusion of lignocaine should only be considered in intensive care patients without MOF or when plasma concentrations of lignocaine are monitored.

Adult↗
PubMed1997

[Multiple organ failure syndrome after ovarian hyperstimulation].

Ovarian stimulation is used to treat female infertility, especially in Black Africa where infertility is considered as shameful. Ovarian stimulation can lead not only to multiple pregnancies but also to severe systemic complications such as the one described in this report. Ovarian stimulation using human menopausal gonadotropin led to ovarian hyperstimulation and multiple organ failure in a 28-year-old Senegalese woman. Symptomatic treatment using corticosteroids, abdominal paracentesis to relieve ascites, and fluid expansion failed. Bilateral ovariectomy was performed resulting in permanent sterility. Ovarian stimulation requires close monitoring by ultrasound visualization and measurement of 17 beta-estradiol to allow early detection of complications.

Adrenal Cortex Hormones↗
PubMed1990

[Preoperative aspects of blood rheology in patients who developed multiple organ failure following cardiac surgery].

The relationship between preoperative hemorheology and postoperative course was studied in 38 patients who had undergone open heart surgery for valvular diseases (mean age, 53 +/- 2 S.E. years). Twelve patients had multiple organ failures (MOF) one week after surgery, while the remaining 26 patients were in satisfactory condition. The hematocrit (Ht) was 34.8 +/- 1.6 S.E.% in patients with MOF and it was 40.4 +/- 0.9 S.E.% in patients without MOF. The difference was significant. Blood viscosities (eta) at shear rates of 94.5 sec-1 and 0.376 sec-1 also were significantly lower in patients with MOF compared with those without MOF. However, oxygen delivery (Ht/eta at a shear rate of 94.5 sec-1) in terms of hemorheology, plasma viscosity, and erythrocyte deformability were not significantly different between the two groups. These data suggest that patients with a low hematocrit and a low viscosity are likely to suffer from MOF following surgery.

Adult↗
PubMed1994

Soluble CD14 (sCD14) levels in patients with multiple organ failure (MOF).

We measured soluble CD14 (sCD14), plasma endotoxin, tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), IL-6, and interferon-gamma (IFN-gamma) in patients with multiple organ failure (MOF). The sCD14 level was significantly higher in septic patients with MOF than that in those without MOF and also higher in non-septic trauma patients with MOF than that in those without MOF. In the septic group with MOF, the sCD14 level correlated significantly with the TNF-alpha level but not the plasma endotoxin, IL-1 beta, IL-6, or IFN-gamma level. These results suggest that the sCD14 level reflects the degree of pathophysiology and that TNF-alpha is involved in stimulating sCD14 production.

Adult↗
PubMed1994

The third component of complement protects against Escherichia coli endotoxin-induced shock and multiple organ failure.

We investigated whether the third component of complement (C3) is involved in the pathophysiology of endotoxic shock, and if it is involved, whether it plays a protective role or whether it mediates shock and multiple organ failure. In a prospective, controlled investigation, six Brittany spaniels that were homozygous for a genetically determined deficiency of C3 (C3 deficient, < 0.003% of normal serum C3 levels) and six heterozygous littermates (controls, approximately 50% of mean normal serum C3 level) were given 2 mg/kg of reconstituted Escherichia coli 026:B6 acetone powder as a source of endotoxin, intravenously. All animals were given similar fluid and prophylactic antibiotic therapy, and had serial hemodynamic variables obtained. After E. coli endotoxin infusion, C3-deficient animals had higher peak levels of endotoxin and less of a rise in temperature than controls (P < 0.05). During the first 4 h after E. coli endotoxin infusion, C3-deficient animals had significantly greater decreases in mean central venous pressure and mean pulmonary artery pressure than controls (P < 0.02). During the first 48 h after E. coli endotoxin infusion, C3-deficient animals had significantly greater decreases in mean arterial pH, left ventricular ejection fraction, and mean pulmonary capillary wedge pressure, and greater increases in mean arterial lactate, arterial-alveolar O2 gradient, and transaminases (aspartate aminotransferase and alanine aminotransferase) than controls, (all P < 0.05). After E. coli endotoxin infusion, C3-deficient animals compared to controls had significantly less of a decrease in mean C5 levels (P < 0.01), but similar (P = NS) increases in circulating tumor necrosis factor levels, bronchoalveolar lavage neutrophils, and protein, and similar (P = NS) decreases in blood leukocytes and platelets. Two of six C3-deficient animals and two of six controls died. In summary, after intravenous infusion of E. coli endotoxin, canines with C3 deficiency have decreased endotoxin clearance and worse E. coli endotoxin-induced shock and organ damage. Thus, the third component of the complement system plays a beneficial role in the host defense against E. coli endotoxic shock.

Analysis of Variance↗
PubMed1994

Posttraumatic multiple organ failure--a report on clinical and autopsy findings.

In a retrospective analysis, clinical data and histological specimens were obtained from patients (n = 59) who died of severe injury. Three groups with comparable injury severity were differentiated according to the time of death. In group A (death, within 24 h) (n = 15) despite multiple injuries, patients almost always died from brain injury. Pulmonary failure was the leading cause of death in group B (death, days 2-7) (n = 16). The majority of group C patients (death, > 7 days) (n = 28) died of multiple organ failure. Organ weights at autopsy were all pathologically high but did not show an association with the amount of intravenous volume infused during intensive care. Organ histology revealed signs of interstitial edema and infiltration of polymorphonuclear leukocytes in group B patients especially in the lung, and in all groups to a lower degree in liver and kidney. The distribution of interstitial edema and cell necrosis appeared to be organ-specific. Our data confirm the presence of a generalized inflammatory reaction in patients with severe trauma. The pattern of organ failure, in addition to known pathogenetic changes (mediators, endotoxemia, etc.), appears to be influenced by organ structure and perfusion.

Adult↗
PubMed2001

Reactivation of human herpesvirus type 6 in multiple organ failure syndrome.

Human herpesvirus type 6 (HHV-6) and cytomegalovirus (CMV) are known to interact with the production of cytokines. In this study, we sought to determine the incidence of HHV-6 and CMV reactivation during multiple organ failure syndrome (MOFS) and to evaluate the potential effects of viral replication on both the morbidity and mortality associated with MOFS. Viral reactivation was assessed by use of specific polymerase chain reaction (PCR) analysis of the serum samples obtained from 48 consecutive patients with MOFS (the MOFS group) and from 48 sex- and age-matched patients with <2 organ failures (the control group). In addition, HHV-6 replication was assessed in 106 blood donors (the normal group). The incidence of HHV-6 replication was higher in the MOFS group than in the control and normal groups (26 [54%] of 48 vs. 7 [15%] of 48 and 5 [5%] of 106, respectively; P<.0001), with apparently no influence on morbidity and mortality rates. In contrast, reactivation of CMV was found in a single patient. Further studies are needed to evaluate the pathogenesis of HHV-6 replication in critically ill patients.

Adolescent↗
PubMed1988

The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens.

The microbiology of infection acquired in the intensive care unit (ICU) was studied prospectively in 205 consecutive patients admitted to a surgical intensive care unit. A multiple organ failure (MOF) score was calculated for each admission. Susceptibility to ICU-acquired infection increased with increasing MOF scores. While Escherichia coli, Bacteroides fragilis, and enterococci were the most common isolates from infections present at the time of ICU admission, Staphylococcus epidermidis, Candida, and Pseudomonas dominated infections occurring in patients with high MOF scores. Mortality correlated highly with infection due to S epidermidis or Candida and only poorly with infection due to Pseudomonas or E coli; significant foci of invasive infection were frequently absent at autopsy. Quantitative cultures of proximal gastrointestinal fluid in 16 of these patients showed Candida, S epidermidis, and Pseudomonas to be the most common isolates, and all but one patient colonized with these organisms had invasive infection with the same organism. The proximal gastrointestinal tract appears to be an important occult reservoir of the predominant pathogens in MOF.

Bacteroides fragilis↗
PubMed1992

[Pharmacological intervention in experimental multiple organ failure in rats].

This paper presents a primary study of the treatment of experimental multiple system organ failure (MSOF) in rats. The rats were pretreated with xanthine oxidase inhibitor allopurinol, the energy metabolism regulator fructose-1,6-diphosphate (FDP) and purified Chinese herbal medicine polydatin. The incidence of MSOF decreased from 71.4% in the untreated group to 35.7%, 47.1% and 16.7% in treated groups, respectively, while the mean survival time was prolonged to 38.5h, 30.2h and 41.7h in treated groups, respectively, as compared with 26.4h in the untreated group. In addition to the known antioxidant effect of the allopurinol, this study also suggests that FDP and polydatin enhance the capacity of antioxidtion.

Allopurinol↗
PubMedDate not supplied

[The role of the intestine in the pathogenesis and treatment of multiple organ failure].

Infection and sepsis remain major causes of death in medical and surgical services, despite the availability of potent antibiotics, aggressive surgery and close monitoring of patients in intensive-care units. Actually the terminology to define this type of events in multiple organ failure: we considered the role of intestine in its pathogenesis and its management.

Animals↗