Multiple organ dysfunction after trauma

被引：93

作者：

Cole, E. ^{[1
]}

Gillespie, S. ^{[1
]}

Vulliamy, P. ^{[1
]}

Brohi, K. ^{[1
]}

Akkad, H. ^{[2
]}

Apostolidou, K. ^{[3
]}

Ardley, R. ^{[4
]}

Aylwin, C. ^{[5
]}

Bassford, C. ^{[6
]}

Bonner, S. ^{[7
]}

Brooks, A. ^{[8
]}

Cairns, T. ^{[9
]}

Cecconi, M. ^{[10
]}

Clark, F. ^{[11
]}

Dempsey, G. ^{[12
]}

Davies, E. Denison ^{[13
]}

Docking, R. ^{[14
]}

Eddlestone, J. ^{[15
]}

Ellis, D. ^{[15
]}

Evans, J. ^{[16
]}

Galea, M. ^{[17
]}

Healy, M. ^{[18
]}

Horner, D. ^{[19
]}

Howarth, R. ^{[20
]}

Jansen, J. ^{[21
,22
,24
]}

Jones, J. ^{[23
]}

Kaye, C. ^{[24
]}

Keep, J. ^{[25
]}

Kerslake, D. ^{[26
]}

Kilic, J. ^{[27
]}

Leong, M. ^{[28
]}

Martinson, V. ^{[29
]}

McIldowie, B. ^{[30
]}

Michael, S. ^{[31
]}

Millo, J. ^{[28
]}

Morgan, M. ^{[32
]}

O'Leary, R. ^{[3
]}

Oram, J. ^{[23
]}

De Gordoa, L. Ortiz-Ruiz ^{[27
]}

Porter, K. ^{[33
]}

Raby, S. ^{[28
]}

Service, J. ^{[14
]}

Shaw, D. ^{[34
]}

Smith, J. D. ^{[35
]}

Smith, N. ^{[29
]}

Stotz, M. ^{[5
]}

Thomas, E. ^{[36
]}

Thomas, M. ^{[30
]}

Vincent, A. ^{[9
]}

Ward, G. ^{[6
]}

机构：

[1] Queen Mary Univ London, Blizard Inst, Ctr Trauma Sci, 4 Newark St, London E1 2AT, England

[2] Queen Mary Univ London, Ctr Trauma Sci, London, England

[3] Cambridge Univ Hosp NHS Fdn Trust, Cambridge, England

[4] Nottingham Univ Hosp NHS Trust, Nottingham, England

[5] Imperial Coll Healthcare NHS Trust, London, England

[6] Univ Hosp Coventry & Warwickshire NHS Trust, Coventry, W Midlands, England

[7] South Tees Hosp NHS Fdn Trust, Middlesbrough, Cleveland, England

[8] Nottingham Univ Hosp NHS Trust, Nottingham, England

[9] Newcastle Upon Tyne Hosp NHS Fdn Trust, Newcastle Upon Tyne, Tyne & Wear, England

[10] St Georges Univ Hosp NHS Fdn Trust, London, England

[11] Univ Hosp North Midlands NHS Trust, Stoke On Trent, Staffs, England

[12] Aintree Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England

[13] Lancashire Teaching Hosp NHS Fdn Trust, Preston, Lancs, England

[14] Queen Elizabeth Univ Hosp Glasgow, Glasgow, Lanark, Scotland

[15] Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England

[16] Salford Royal NHS Fdn Trust, Salford, Lancs, England

[17] Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England

[18] Barts Hlth NHS Trust, London, England

[19] Salford Royal NHS Fdn Trust, Salford, Lancs, England

[20] Lancashire Teaching Hosp NHS Fdn Trust, Preston, Lancs, England

[21] Aberdeen Royal Infirm, Aberdeen, Scotland

[22] Univ Alabama Birmingham, Birmingham, AL USA

[23] Leeds Teaching Hosp NHS Trust, Leeds, W Yorkshire, England

[24] Aberdeen Royal Infirm, Aberdeen, Scotland

[25] Kings Coll Hosp NHS Fdn Trust, London, England

[26] Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland

[27] Brighton & Sussex Univ Hosp NHS Trust, Brighton, E Sussex, England

[28] Oxford Univ Hosp NHS Fdn Trust, Oxford, England

[29] Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, England

[30] North Bristol NHS Trust, Bristol, Avon, England

[31] Sheffield Teaching Hosp NHS Fdn Trust, Sheffield, S Yorkshire, England

[32] Univ Hosp Wales, Cardiff, S Glam, Wales

[33] Univ Hosp Birmingham NHS Fdn Trust, Birmingham, W Midlands, England

[34] Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Liverpool, Merseyside, England

[35] Ninewells Hosp, Dundee, Scotland

[36] Plymouth Hosp NHS Trust, Plymouth, Devon, England

来源：

BRITISH JOURNAL OF SURGERY | 2020年 / 107卷 / 04期

关键词：

PERSISTENT INFLAMMATION; FLUID RESUSCITATION; HEMORRHAGIC-SHOCK; BRAIN-INJURY; SOFA SCORE; FAILURE; DENVER; IMMUNOSUPPRESSION; EPIDEMIOLOGY; ASSOCIATION;

D O I：

10.1002/bjs.11361

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

BackgroundThe nature of multiple organ dysfunction syndrome (MODS) after traumatic injury is evolving as resuscitation practices advance and more patients survive their injuries to reach critical care. The aim of this study was to characterize contemporary MODS subtypes in trauma critical care at a population level. MethodsAdult patients admitted to major trauma centre critical care units were enrolled in this 4-week point-prevalence study. MODS was defined by a daily total Sequential Organ Failure Assessment (SOFA) score of more than 5. Hierarchical clustering of SOFA scores over time was used to identify MODS subtypes. ResultsSome 440 patients were enrolled, of whom 245 (557 per cent) developed MODS. MODS carried a high mortality rate (220 per cent versus 05 per cent in those without MODS; P<0001) and 240 per cent of deaths occurred within the first 48h after injury. Three patterns of MODS were identified, all present on admission. Cluster 1 MODS resolved early with a median time to recovery of 4days and a mortality rate of 144 per cent. Cluster 2 had a delayed recovery (median 13days) and a mortality rate of 35 per cent. Cluster 3 had a prolonged recovery (median 25days) and high associated mortality rate of 46 per cent. Multivariable analysis revealed distinct clinical associations for each form of MODS; 24-hour crystalloid administration was associated strongly with cluster 1 (P = 0009), traumatic brain injury with cluster 2 (P = 0002) and admission shock severity with cluster 3 (P = 0003). ConclusionContemporary MODS has at least three distinct types based on patterns of severity and recovery. Further characterization of MODS subtypes and their underlying pathophysiology may lead to future opportunities for early stratification and targeted interventions.

引用

页码：402 / 412

页数：11

共 44 条

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