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An Independent Risk Factor for Postinjury Multiple Organ Failure

Frederick A. Moore, MD; Ernest E. Moore, MD; Angela Sauaia, MD

Arch Surg. 1997;132(6):620-625.

Abstract
Objective
To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes.

Design
A 55-month inception cohort study ending on August 30, 1995. Data characterizing postinjury MOF were prospectively collected. Multiple logistic regression analysis was performed on 5 sets of data. Set 1 included admission data (age, sex, comorbidity, injury mechanism, Glasgow Coma Scale, Injury Severity Score, and systolic blood pressure determined in the emergency department) plus the amount of blood transfused within the first 12 hours. In the subsequent 4 data sets, other indexes of shock (early base deficit, early lactate level, late base deficit, and late lactate level) were sequentially added. Additionally, the same multiple logistic regression analyses were performed with early MOF and late MOF as the outcome variables.

Setting
Denver General Hospital, Denver, Colo, is a regional level I trauma center.

Patients
Five hundred thirteen consecutive trauma patients admitted to the trauma intensive care unit with an Injury Severity Score greater than 15 who were older than 16 years and who survived longer than 48 hours.

Interventions
None.

Main Outcome Measures
The relationship of blood transfusions and other shock indexes with the outcome variable, MOF.

Results
A dose-response relationship between early blood transfusion and the later development of MOF was identified. Despite the inclusion of other indexes of shock, blood transfusion was identified as an independent risk factor in 13 of the 15 multiple logistic regression models tested; the odds ratios were high, especially in the early MOF models.

Conclusion
Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.

Arch Surg. 1997;132:620-625

Author Affiliations
From the Departments of Surgery, University of Texas Medical School at Houston and Hermann Hospital, Houston (Dr F. A. Moore); Denver General Hospital, Denver, Colo (Drs E. E. Moore and Sauaia); and Departments of Surgery (Dr E. E. Moore) and Preventive Medicine and Biometrics (Dr Sauaia), University of Colorado Health Sciences Center, Denver.

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