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Multiple-organ failure. Generalized autodestructive inflammation?
Abstract:
As multiple-organ failure (MOF) has been generally associated with sepsis, the importance of bacterial sepsis was evaluated retrospectively in 55 trauma and 37 intra-abdominal-sepsis patients with MOF. The severity of MOF was graded, and an analysis was made of day of onset, incidence, severity, sequence, and mortality of organ failures. No difference was found between groups in sequence, severity, or mortality of organ failures. In contrast, bacterial sepsis was found in 65% of intra-abdominal-sepsis patients but only in 33% of trauma patients. It is concluded that sepsis is probably not the essential cause of MOF. Instead, an alternative hypothesis is presented involving massive activation of inflammatory mediators by severe tissue trauma or intra-abdominal sepsis, resulting in systemic damage to vascular endothelia, permeability edema, and impaired oxygen availability to the mitochondria despite adequate arterial oxygen transport.
Insights
Bacterial sepsis is not the primary cause of multiple-organ failure (MOF). Severe trauma or intra-abdominal sepsis may trigger inflammatory responses leading to MOF, independent of bacterial infection.
Area of Science:
- Critical Care Medicine
- Sepsis Pathophysiology
- Trauma Management
Background:
- Multiple-organ failure (MOF) is a common complication in critically ill patients.
- Bacterial sepsis is often considered a leading cause of MOF.
- The specific role of bacterial sepsis versus other triggers in MOF requires further clarification.
Purpose of the Study:
- To retrospectively evaluate the association between bacterial sepsis and MOF in trauma and intra-abdominal sepsis patients.
- To compare the incidence, severity, and mortality of MOF in patients with and without bacterial sepsis.
- To explore alternative hypotheses for MOF development in severe trauma and intra-abdominal sepsis.
Main Methods:
- Retrospective analysis of 55 trauma patients and 37 intra-abdominal sepsis patients with MOF.
- Grading the severity of MOF and analyzing the day of onset, incidence, severity, sequence, and mortality of organ failures.
- Assessing the presence of bacterial sepsis in both patient groups.
Main Results:
- No significant differences were found in the sequence, severity, or mortality of organ failures between trauma and intra-abdominal sepsis groups.
- Bacterial sepsis was identified in 65% of intra-abdominal sepsis patients compared to 33% of trauma patients.
- These findings suggest bacterial sepsis may not be the essential cause of MOF.
Conclusions:
- Sepsis is likely not the essential cause of multiple-organ failure (MOF).
- Severe tissue trauma or intra-abdominal sepsis may induce MOF through massive inflammatory mediator activation.
- This inflammatory cascade can lead to endothelial damage, edema, and impaired mitochondrial oxygen availability, irrespective of bacterial infection.