Department of Traumatology, John Hunter Hospital, HRMC, Locked Bag 1, Newcastle, NSW, 2310, Australia.
University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Eur J Trauma Emerg Surg. 2024 Feb;50(1):131-138. doi: 10.1007/s00068-022-02202-8. Epub 2023 Jan 4.
Recently, retrospective registry-based studies have reported the decreasing incidence and increasing mortality of postinjury multiple organ failure (MOF). We aimed to describe the current epidemiology of MOF following the introduction of haemostatic resuscitation.
A 10-year prospective cohort study was undertaken at a Level-1 Trauma Centre-based ending in December 2015. Inclusion criteria age ≥ 16 years, Injury Severity Score (ISS) > 15, Abbreviated Injury Scale (AIS) Head < 3 and survived > 48 h. Demographics, physiological and shock resuscitation parameters were collected. The primary outcome was MOF defined by a Denver Score > 3.
intensive care unit length of stay (ICU LOS), ventilation days and mortality.
Three hundred and forty-seven patients met inclusion criteria (age 48 ± 20; ISS 30 ± 11, 248 (71%) were males and 23 (6.6%) patients died. The 74 (21%) MOF patients (maximum Denver Score: 5.5 ± 1.8; Duration; 5.6 ± 5.8 days) had higher ISS (32 ± 11 versus 29 ± 11) and were older (54 ± 19 versus 46 ± 20 years) than non-MOF patients. Mean daily Denver scores adjusted for age, sex, MOF and ISS did not change over time. Crystalloid usage decreased over the 10-year period (p value < 0.01) and PRBC increased (p value < 0.01). Baseline cumulative incidence of MOF at 28 days was 9% and competing risk analyses showed that incidence of MOF increased over time (subdistribution hazard ratio 1.14, 95% CI 1.04 to 1.23, p value < 0.01). Mortality risk showed no temporal change. ICU LOS increased over time (subdistribution hazard ratio 0.95, 95% CI 0.92 to 0.98, p value < 0.01). Ventilator days increased over time (subdistribution hazard ratio 0.94, 95% CI 0.9 to 0.97, p value < 0.01).
The epidemiology of MOF continues to evolve. Our prospective cohort suggests an ageing population with increasing incidence of MOF, particularly in males, with little changes in injury or shock parameters, who are being resuscitated with less crystalloids, stay longer on ICU without improvement in survival.
最近，回顾性登记研究报告称创伤后多器官衰竭（MOF）的发病率降低，死亡率升高。我们旨在描述止血复苏后 MOF 的当前流行病学。
这是一项在 2015 年 12 月结束的一级创伤中心进行的为期 10 年的前瞻性队列研究。纳入标准为年龄≥16 岁，损伤严重程度评分（ISS）>15，简明损伤量表（AIS）头部<3，存活时间>48 小时。收集人口统计学、生理和休克复苏参数。主要结局为 Denver 评分>3 定义的 MOF。
重症监护病房（ICU）住院时间（ICU LOS）、通气天数和死亡率。
347 名患者符合纳入标准（年龄 48±20 岁；ISS 30±11，248 名（71%）为男性，23 名（6.6%）患者死亡。74 名（21%）MOF 患者（最大 Denver 评分：5.5±1.8；持续时间；5.6±5.8 天）的 ISS 更高（32±11 比 29±11）且年龄更大（54±19 比 46±20 岁）。调整年龄、性别、MOF 和 ISS 的每日平均 Denver 评分随时间没有变化。10 年间晶体液用量减少（p 值<0.01），PRBC 增加（p 值<0.01）。28 天时 MOF 的累积发生率为 9%，竞争风险分析显示 MOF 的发生率随时间增加（亚分布危险比 1.14，95%CI 1.04 至 1.23，p 值<0.01）。死亡率没有随时间变化。ICU LOS 随时间增加（亚分布危险比 0.95，95%CI 0.92 至 0.98，p 值<0.01）。通气天数随时间增加（亚分布危险比 0.94，95%CI 0.9 至 0.97，p 值<0.01）。
MOF 的流行病学仍在不断演变。我们的前瞻性队列研究表明，人口老龄化，MOF 的发病率增加，特别是男性，受伤或休克参数变化不大，接受晶体液复苏治疗减少，在 ICU 停留时间延长，但生存率没有提高。
