Correlation between Changes in Mediators and Number of Dysfunctional Organs in Sepsis-Associated Multiple Organ Dysfunction Syndrome (MODS)

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  • Taniuchi,Hitoshi
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Ikeda,Toshiaki
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Ikeda,Kazumi
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Matsushita,Mikiko
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Nagura,Masatoshi
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Kiuchi,Shintarou
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Kuroki,Yuichi
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University
  • Suzuki,Kaori
    Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University

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Other Title
  • 敗血症性多臓器不全 : 障害臓器数と病態,各種mediatorとの関連(<特集>多臓器不全とアフェレシス)

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Description

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. This study included 116 cases of MODS which were treated with PMX-DHP. Background factors, circulatory parameters and inflammatory mediators 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 1 point for each organ. 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 and the SOFA score significantly increased with an increase in dysfunctional organs, with a significant correlation (p<0.0001). The mean IL-6 level was highest in cases with dysfunction of 4 organs. The BNP level appeared to increase as the number of organs in dysfunction increased. A variety of humoral mediators, including cytokines, increased as the number of dysfunctional organ increased, while the level of the increase differed for each mediator. Possible involvement of BNP was suggested in the development of sepsis-associated MODS and will be further studied in the future.

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