Correlation between changes in mediators and number of dysfunctional organs in sepsis-associated multiple organ dysfunction syndrome (MODS)

Introduction

Changes in hemodynamics and a variety of mediators such as cytokines were compared with respect to the number of dysfunctional organs in MODS cases treated with blood purification.

Subjects and methods

This study included 113 cases of MODS that were treated with endotoxin-absorption therapy (PMX-DHP). Background factors, respiration, circulatory parameters and inflammatory mediators (IL-6, IL-1ra, ELAM-1, PAI-1, MIP-1α and BNP) were measured before the start of PMX-DHP. Organ dysfunction was evaluated using the MOF score according to Goris, where organ dysfunction was judged positive when the score was more than one point for each organ.

Results

The rate of survival for more than 28 days from the start of blood purification clearly decreased as the number of dysfunctional organs increased. The APACHE II score, the Septic Severity Score (SSS), and the SOFA score significantly increased with an increase in dysfunctional organs, with a significant positive correlation (P < 0.0001) between the scores (r = 0.59 between APACHE II and SOFA, r = 0.60 between APACHE II and SSS, and r = 0.76 between SSS and SOFA). In comparison, by prognosis, the number of dysfunctional organs was 3.1 ± 1.2 in survival cases and 4.3 ± 1.0 in the nonsurvival cases before the start of blood purification. The mean IL-6 level was highest in cases with dysfunction of four organs. The BNP level appeared to increase as the number of organs with dysfunction increased. In particular, the difference between the two-organ dysfunction group and the three-organ dysfunction group was statistically significant (P < 0.05).

Conclusion

A variety of humoral mediators, including cytokines, increased as the number of dysfunctional organs increased, while the level of the increase differed for each mediator. Hemodynamics and PaO₂/FiO₂ ratio prior to the start of PMX-DHP appeared to influence the prognosis. Possible involvement of BNP was suggested in development of sepsis-associated MODS and will be further studied in the future.