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The role of infection in outcome of Multiple Organ Failure
G V Poole1, F F Muakkassa, J A Griswold
1Department of Surgery, University of Mississippi Medical Center, Jackson 39216.
Abstract:
It is widely assumed that infections are the principal cause and primary outcome determinant of the syndrome of Multiple Organ Failure (MOF) in critically ill patients. Infections are frequent in these patients, but the prevention and treatment of infections may not influence the course of MOF. This study tested the hypothesis that infections play a decisive role in the outcome of MOF. Data were gathered concurrently on all adult patients admitted over an 18-month period to a non-cardiac surgical ICU at a university hospital and recorded in a computer database. Sepsis was defined as a state characterized by at least three of the following: fever, tachycardia, leukocytosis or leukopenia, increased cardiac index, reduced systemic vascular resistance, and hypercatabolism manifested by nitrogen-wasting. The presence of an infection was not required for the diagnosis of sepsis. Mild sepsis was defined as the presence of three or four parameters. Severe sepsis was defined as the presence of five or six parameters. MOF was defined as the development of dysfunction of at least two of the following major organ systems: cardiac, gut, pulmonary, renal, cerebral, and hepatic. Of 749 admissions, 73 patients developed MOF. Thirty four (47%) had a documented source of infection, 37 (51%) had positive blood cultures, and all had sepsis. Hospital mortality was 66 percent (48 of 73 patients). Death could not be predicted by bacteremia (P > 0.25), nor by the presence of an infectious source (P = 1.0), but was strongly associated with severe sepsis (P < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Severe sepsis, not infection, strongly predicts mortality in critically ill patients with Multiple Organ Failure (MOF). This finding challenges the assumption that infections are the primary driver of MOF outcomes.
Area of Science:
- Critical Care Medicine
- Pathophysiology
- Sepsis Research
Background:
- Multiple Organ Failure (MOF) is a critical condition in intensive care units.
- Infections are frequently observed in MOF patients and often assumed to be the primary cause.
- The direct impact of infection on MOF prognosis remains debated.
Purpose of the Study:
- To investigate the hypothesis that infections play a decisive role in the outcome of MOF.
- To differentiate the impact of sepsis severity from the presence of infection on MOF mortality.
Main Methods:
- Prospective data collection from adult patients in a surgical ICU over 18 months.
- Defined sepsis based on clinical parameters (fever, tachycardia, etc.), with severity categorized as mild or severe.
- Defined MOF as dysfunction in at least two major organ systems.
Main Results:
- Of 749 admissions, 73 developed MOF; 66% (48/73) died.
- Presence of infection or bacteremia did not predict mortality.
- Severe sepsis was strongly associated with increased hospital mortality (P < 0.0005).
Conclusions:
- The severity of sepsis, rather than the presence of infection, is a strong predictor of mortality in MOF.
- Findings suggest that MOF management should focus on sepsis severity, potentially independent of infection source control.