EARLY PREDICTORS OF POSTINJURY MULTIPLE ORGAN FAILURE

Objective: To find a predictive model for postinjury multiple organ fa ilure (MOF). Design: A 3-year cohort study ending December 1992 (first year: retrospective; last 2 years: prospective). Setting: Denver Gene ral Hospital (Cole) is a regional level I trauma center. Patients: Con secutive trauma patients with an Injury Severity Score (ISS) greater t han 15, with an age greater than 16 years, and who survived longer tha n 24 hours. Stepwise logistic regression analysis was performed in all patients (n=394), in the subgroup of patients with 0 to 12 hours, plu s 12 to 24 hours base deficit (BD) results (n=220), and in a second su bgroup of patients with BD plus lactate results at 0 to 12 hours and 1 2 to 24 hours (n=106). Main Outcome: Postinjury MOF. Results: The foll owing variables were identified as independent predictors of MOF in th e analysis of all patients: age more than 55 years, ISS greater than o r equal to 25, and more than 6 U of red blood cells in the first 12 ho urs after admission (U RBC/12 hours). In the subgroup with BD results, the same analysis identified age greater than 55 years, greater than 6 U RBC/12 hours, and BD greater than 8 mEq/L (0 to 12 hours), while i n the last subgroup analysis including BD and lactate results, greater than 6 U RBC/12 hours, BD greater than 8 mEq/L (0 to 12 hours), and l actate greater than 2.5 mmol/L (12 to 24 hours) were independently ass ociated with MOF. Conclusions: Age greater than 55 years, ISS greater than or equal to 25, and greater than 6 U RBC/12 hours are early indep endent predictors of MOF. Subgroup analyses indicate that BD and lacta te levels may add substantial predictive value. Moreover, these result s emphasize the predominant role of the initial insult in the pathogen esis of postinjury MOF.