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Epidemiology of postinjury multiple organ failure: a prospective multicenter observational study
Ryan S Ting1, Natasha A Weaver2, Kate L King3
1St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
Purpose:
Postinjury multiple organ failure (MOF) is the sequela to the disease of polytrauma. We aimed to describe the contemporary population-based epidemiology of MOF within a mature trauma system, to analyse the time taken for MOF to develop, and to evaluate the temporal patterns and contributions of the individual constituent organ failures.
Methods:
Prospective observational study conducted across five Level-1 trauma centers in New South Wales, Australia. Trauma patients at-risk of MOF (Denver > 3 from 48 h post-admission), aged > 16 years, ISS > 15, and who stayed in ICU for ≥ 48 h were eligible for inclusion.
Results:
From May 2018-February 2021, 600 at-risk polytrauma patients were prospectively enrolled (mean(SD)age = 49(21)years, males = 453/600(76%),median(IQR)ISS = 26(20,34)). MOF incidence was 136/600(23%) among at-risk patients, 142/6248(2%) among major trauma patients (ISS > 12 per Australian definition), and 0.8/100,000 in the general population. The mortality rate was 55/600(11%) in the overall study population, and 34/136(25%) in MOF patients. 82/136(60%) of MOF patients developed MOF on day-3. No patients developed MOF after day-13. Among MOF patients, 60/136(44%) had cardiac failures (mortality = 37%), 39/136(29%) had respiratory failures (mortality = 23%), 24/136(18%) had renal failures (mortality = 63%), and 12/136(9%) had hepatic failures (mortality = 50%).
Conclusion:
Although a rare syndrome in the general population, MOF occurred in 23% of the most severely injured polytrauma patients. When compared to previous risk-matched cohorts, MOF become more common, but not more lethal, despite a decade older cohort. The heart has superseded the lungs as the most common organ to fail. Cardiac and respiratory failures occurred earlier and were associated with lower mortality than renal and hepatic failures.
Insights
Multiple organ failure (MOF) affects 23% of severely injured trauma patients, with cardiac failure now most common. While MOF incidence increased, its lethality remained stable in this contemporary cohort.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Epidemiology
Background:
- Postinjury multiple organ failure (MOF) is a significant sequela of polytrauma.
- Understanding MOF epidemiology is crucial for improving outcomes in mature trauma systems.
Purpose of the Study:
- To describe the population-based epidemiology of MOF in a mature trauma system.
- To analyze the timing of MOF development and the patterns of individual organ failures.
Main Methods:
- Prospective observational study across five Level-1 trauma centers in Australia.
- Included at-risk polytrauma patients (Denver > 3, ISS > 15, ICU stay ≥ 48 hours).
- Data collected from May 2018 to February 2021.
Main Results:
- MOF incidence was 23% in at-risk patients, significantly lower in major trauma and the general population.
- The mortality rate was 11% overall and 25% in MOF patients.
- Cardiac failure (44%) superseded respiratory failure (29%) as the most common MOF, with renal and hepatic failures having higher mortality.
Conclusions:
- MOF remains a critical complication in severely injured patients, occurring more frequently but not more lethally than in older cohorts.
- Cardiac failure is now the predominant organ system affected in MOF.
- Early cardiac and respiratory failures had lower mortality than later renal and hepatic failures.
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