Abstract
Purpose: We sought to identify a MODS score parameter that highly correlates with adverse outcomes and then use this parameter to test the hypothesis that multiple severity-based MODS clusters could be identified after blunt trauma.Methods: MOD score across days (D) 2–5 was subjected to Fuzzy C-means Clustering Analysis (FCM) followed by eight Clustering Validity Indices (CVI) to derive organ dysfunction patterns among 376 blunt trauma patients admitted to the intensive care unit (ICU) who survived to discharge. Thirty-one inflammation biomarkers were assayed (Luminex™) in serial blood samples (3 samples within the first 24 h and then daily up to D 5) and were analyzed using Two-Way ANOVA and Dynamic Network analysis (DyNA).Results: The FCM followed by CVI suggested four distinct clusters based on MOD score magnitude between D2 and D5. Distinct patterns of organ dysfunction emerged in each of the four clusters and exhibited statistically significant differences with regards to in-hospital outcomes. Interleukin (IL)-6, MCP-1, IL-10, IL-8, IP-10, sST2, and MIG were elevated differentially over time across the four clusters. DyNA identified remarkable differences in inflammatory network interconnectivity.Conclusion: These results suggest the existence of four distinct organ failure patterns based on MOD score magnitude in blunt trauma patients admitted to the ICU who survive to discharge.
Highlights
Trauma remains the leading cause of mortality and morbidity for individuals under 55 years and accounts for 30% of all life-years lost, with over 190,000 lives lost annually in the USA [1, 2]
Out of the 493 patients enrolled in the observational study, we identified a subset of patients (n = 376) with complete sequential Multiple Organ Dysfunction (MOD) score data who remained in the intensive care unit (ICU) for at least 5 days postinjury
We focused on days 2–5 because this incorporates the known peak in multiple organ dysfunction syndrome (MODS) post-injury [20] but avoids the impact of inadequate resuscitation on MOD score sometimes observed in the first 24 h
Summary
Trauma remains the leading cause of mortality and morbidity for individuals under 55 years and accounts for 30% of all life-years lost, with over 190,000 lives lost annually in the USA [1, 2]. A common central factor contributing to outcomes following injury is the accompanying immuno-inflammatory response. A dysregulated response is associated with multiple organ dysfunction syndrome (MODS) which can evolve to a state of persistent critical illness and a continued increased risk for complications and death after discharge [11,12,13]. Trauma-induced MODS is widely believed to be the leading cause of death among ICU patients being responsible for 50–80% of ICU mortality [14, 15]. To do this, there is a need to define the patterns of organ dysfunction in trauma patients that survive the early mortality window and whether distinct MODS patterns are associated with identifiable differences in the early systemic inflammatory response
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