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[Clinical study of the pathogeneses of multiple organ failure after burns]
1Burn Institute, Southwestern Hospital.
Abstract:
51 burned patients with TBSA over 30% were studied prospectively. MOF developed in 17 of them. Postburn MOF occurred mainly in those with TBSA over 70%. Mortality of MOF was directly proportional to the number of organs involved. The incidence of pulmonary failure was the highest, and the highest mortality was attributed to renal failure. MOF occurring in the early stage was more related to burn shock, and those occurring in the late stage was predisposed mainly by infection. Oxygen free radicals play an important role in the genesis and development of postburn MOF. In this study, it was revealed that antiperoxidation ability declined, active oxygen was increased, and lipid peroxidation became excessive after the burn injury. It was also found that oxygen free radical-mediated effects produced more serious damages in patients with MOF than those without, and also more in those died than the survivors. The hypoxanthine-xanthine oxidase system was a significant source of oxygen radicals after the burn injury. There were also significant changes in plasma TXA2 and PGI2 levels postburn. The marked increase in TXA2/PGI2 ratio indicated imbalance between TXA2 and PGI2, which was correlated well with burn size and closely related to the development of postburn MOF. The excessive production of TXA2 might trigger or accelerate the formation of microaggregates and thromboxane, subsequently leading to visceral damages and failure.
Insights
Severe burns (TBSA > 30%) can lead to multiple organ failure (MOF), particularly in patients with extensive burns (TBSA > 70%). Oxygen free radicals and TXA2/PGI2 imbalance are key factors in MOF development and mortality.
Area of Science:
- Biomedical Science
- Physiology
- Pathology
Context:
- Studied 51 burn patients with TBSA > 30% to investigate postburn Multiple Organ Failure (MOF).
- MOF incidence was higher in patients with TBSA > 70%, with mortality directly proportional to the number of organs affected.
Purpose:
- To explore the role of oxygen free radicals and plasma TXA2/PGI2 levels in the development and mortality of postburn MOF.
- To identify risk factors and mechanisms contributing to MOF in severe burn patients.
Summary:
- Postburn MOF occurred in 17 patients, primarily those with TBSA > 70%. Pulmonary failure was most common, while renal failure had the highest mortality.
- Early MOF linked to burn shock; late MOF to infection. Declining antiperoxidation and increased lipid peroxidation were observed.
- Oxygen free radicals, particularly from the hypoxanthine-xanthine oxidase system, exacerbated MOF. Increased TXA2/PGI2 ratio correlated with burn size and MOF development.
Impact:
- Findings highlight the critical role of oxidative stress and eicosanoid imbalance in severe burn outcomes.
- Identifies potential therapeutic targets for preventing or mitigating MOF in burn patients.
- Provides insights into the pathophysiology of MOF, aiding clinical management and improving patient survival rates.