Analysis of multiple organ system failure in trauma and nontrauma patients.

Multiple organ failure (MOF), a syndrome of recent evolution, has resulted from advancements in both surgical and trauma care. A prospective study of organ failure (OF) was conducted for 203 consecutive admissions to the surgical intensive care unit (SICU) between September 1986 and June 1987. Diagnosis, operations, age, OF, outcome, and culture data were recorded for each patient. OF definitions consistent with the literature were used to identify pulmonary, renal, hepatic, cardiovascular (CVS), gastrointestinal (GI), hematologic-coagulation, and central nervous system (CNS) failure. Eighty-two patients developed OF (40.4% incidence). The distribution of OF was 65 per cent trauma (T) and 35 per cent nontrauma (NT). Combined mortality for OF was 46 per cent (T = 34% and NT = 69%). The mortality of organ failure increased with the number of failed systems in the total population as well as in both T and NT groups. For the total population, the mortality by number of systems failed was no system, 1.3 per cent; one system, 13 per cent; two systems, 34.5 per cent; three systems, 75 per cent; four or more systems, 92.9 per cent. The incidence and mortality for each system is listed. Sepsis occurred in 62.1 per cent of NT patients (88.9% mortality) and in 30.2 per cent of T patients (31.3% mortality). Mortality was weakly associated with age in groups matched for severity of OF.