The impact of liver dysfunction on outcome in patients with multiple injuries

Multiple organ dysfunction syndrome (MODS) is the leading cause of late dea ths after traumatic injury. The relative importance of dysfunction of indiv idual organ systems in determining outcome from MODS has not been clearly d efined. Some studies have suggested that hepatic dysfunction associated wit h MODS increases mortality, whereas others have suggested that it contribut es little to outcome in trauma patients. To clarify the role of the hepatic dysfunction after traumatic injury we retrospectively reviewed all trauma patients with an Injury Severity Score greater than or equal to 14 admitted from January 1, 1994 through June 30, 1997 for the presence of hepatic dys function defined as a serum bilirubin greater than or equal to2.0 mg/dL. Of the 1962 patients who met the entry criteria 154 developed hepatic dysfunc tion during their hospital stay. Patients with hepatic dysfunction were old er (46 +/- 2 versus 41 +/- 1 years), were more severely injured (Injury Sev erity Score 31.5 +/- 0.9 versus 23.3 + 0.2), and had a lower prehospital bl ood pressure (102 +/- 3 versus 117 +/- 1 mm Hg) compared with patients who did not develop hepatic dysfunction. Patients with hepatic dysfunction were more likely to present with shock as reflected in a lower initial emergenc y room blood pressure (109 +/- 3 versus 128 +/- 1 mm Hg) and base deficit ( -6.9 +/- 0.6 versus -3.5 +/- 0.1 mEq/L). Patients who developed hyperbiliru binemia had longer lengths of stay in the intensive care unit (15.8 +/- 1.2 versus 3.4 +/- 0.2 days) and the hospital (27.4 +/- 1.7 versus 11.1 +/- 0. 2 days) and a higher in-hospital mortality (16.2% versus 2.5%). These data demonstrate that the development of hepatic dysfunction reflects the severi ty of injury and is associated with a significantly worse outcome after tra umatic injury.