One of the challenges in providing emergency care to critically injured patients is determining which ones are more likely to develop multiple organ failure.

Research from Queen Mary University of London (QMUL) suggests that testing blood samples within the first two hours of injury might help with that prediction. The article in PLOS Medicine notes that a specific immune response to trauma occurs shortly after injury and could also help with the development of new therapies.

Background information in the report notes that Multiple Organ Dysfunction Syndrome (MODS) is the failure of several organs, including lung, heart, kidney, and liver, which leads to mortality and greater morbidity in patients who survive their initial physical trauma.

Lead researcher Karim Brohi, MD, of QMUL's Centre for Trauma Sciences says the 24-72 hours after a traumatic injury are imperative to the patient’s immune response, and may be a major factor for whether they develop organ failure. Brohi adds that studying this timeframe is challenging due to the characteristics of an emergency environment, but a better understanding of what causes MODS may dramatically improve patient outcomes.

For the study, the team focused on blood samples from 70 critically injured patients at the Royal London Hospital, which were drawn within two hours of arrival in the resuscitation room. Those were compared with blood samples taken at 24 hours and 72 hours after injury, and with samples from other patients with minor injuries and healthy volunteers.

Immediately after injury, only 1,239 immune gene cells out of 29,385 were identified as different between critical and control patients. By 24 hours after injury, the response had grown into a widespread immune reaction involving a “genomic storm” of 6,294 genes, the researchers reported.

The study team pointed out that when comparing the immune cell genes expressed in patients who later developed MODS to those who did not, the greatest differences were seen immediately after injury, where 363 genes had different activity levels between MODS and non-MODS patients, compared to only 33 genes 24 hours later. They suggest that the response of these early genes could, with more research, help determine which patients will develop MODS after a traumatic injury.

Further analysis of these genes during the initial two-hour window determined that the development of MODS was associated with biological pathways associated with cell death and survival, rather than inflammatory pathways, which differed from previous studies. Past research has suggested that excessive inflammation produced organ dysfunction, according to the article.
 

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