Reticuloendothelial system activity and organ failure in patients with multiple injuries

Hypothesis: Reticuloendothelial system function is altered in patients with multiple trauma and organ failure. Design: Prospective cohort study. Setting: Surgical intensive case unit at a level I trauma center. patients: Patients with multiple blunt trauma and injury severity scores greater than 20, with no referrals. Interventions: Every second day reticuloendothelial system (RES) clearance capacity and liver blood flow were determined by administering labeled huma n albumin. Liver function was measured by enzymatic decay of indocyanine gr een, and levels of plasma tumor necrosis factor alpha were evaluated. Results: In nonsurviving patients with blunt trauma, RES function was alter ed and was associated with organ dysfunction and infectious complications. Of 61 patients, 42 survived and 19 did not. Sixteen patients (84%) died of multiple organ failure. Significantly elevated RES activity (colloid cleara nce rate) was present between day 5 and day 13 after trauma in nonsurvivors (0.86 +/- 0.16 [mean +/- SD] on day 7, P = .003) compared with survivors ( 0.48+/-0.08 on day 7) and 20 healthy volunteers (0.47 +/- 0.06); RES activi ty then decreased to subnormal levels in nonsurvivors. Tumor necrosis facto r alpha plasma levels were elevated early after injury only in nonsurvivors ton day 1:nonsurvivors, 1.2 +/- 0.4 ng/mL [mean +/- SD]; survivors, 0.5 +/ - 0.2 ng/mL; P = .02). Indocyanine green half-life values increased late af ter trauma, indicating late organ failure (on day 19: nonsurvivors, 111 +/- 29 minutes [mean +/- SD]; survivors, 12 +/- 4 minutes; P<.001). Conclusions: Early after trauma, nonsurviving patients demonstrated increas ed proinflammatory cytokine levels, followed by a state of pathological hyp eractivation of the reticuloendothelial system prior to death. These result s indicate that the stationary host defense system is involved in the mecha nisms causing organ failure after severe trauma.