EARLY RISK-FACTORS FOR POSTINJURY MULTIPLE ORGAN FAILURE

Epidemiologic studies, based on retrospective data from heterogeneous populations with poor control of confounders, led early investigators to conclude that infection,vas the overriding risk factor for multiple organ failure (MOF). More recent studies have convincingly shown that MOF frequently occurs in the absence of infection. Consequently, we h ave shifted our research focus away from the traditional infections mo dels of MOF to the newer ''one-hit'' and ''two-hit'' inflammatory mode ls. Clinically, we have chosen to study trauma patients because they a re a relatively homogeneous group with a low incidence of common confo unders. Trauma also permits a clear distinction between the first insu lt and the outcome, both temporally and with respect to the definition criteria. In this review we discuss the background, rationale, and ou r initial attempts to use indicators of the first insult (i.e., tissue injury quantification and clinical signs of shock) and indicators of the host response (i.e., systemic inflammatory response syndrome) to p redict MOF early after injury.