Establishment of a new Severity Scoring System for the Patients with Multiple Organ Failure from the Aspect of Cellular Injury - Anoxic Necrosis and Apoptosis

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Multiple organ failure (MOF) still has a poor prognosis and ranks at the top of the cause of death in critically ill patients. In the treatment of MOF, accurate evaluation of severity is important in determining therapeutic approach, assessing benefits of various treatments, predicting outcome and in decision making for withholding or withdrawal of treatments in patients who are unlikely to survive. This study was undertaken to establish the accurate severity scoring system for MOF patients from the aspect of cellular injury caused by anoxic necrosis and apoptosis. We have developed and clinically used cellular injury score (CIS), derived from 3 intracellular metabolic parameters, arterial ketone body ratio (AKBR), osmolality gap (OG) and blood lactate to evaluate the cellular injury caused by anoxic necrosis. We clinically evaluated the usefulness of CIS as the severity scoring system in 157 MOF patients and 47 multiple organ dysfunction syndrome (MODS) patients in comparison with sep … More sis-related organ failure assessment (SOFA) score. We found that CDS well reflected the severity and outcome of the MOF patients and that CDS is clinically useful severity scoring system. From the comparison with SOFA score, we found that CDS and SOFA are comparable for the evaluation of severity and for mortality prediction, and that sequential evaluation of these two severity scoring system would enable more accurate prediction. However, CIS does not always reflect severity in some patients received prolonged treatment. Cell death caused by apoptosis may involve in the development of organ failure in these patients. We investigated apoptosis related substances in plasma from MOF patients, such as nuclear matrix protein, soluble Fas ligand and various cytokines to determine the indices reflecting apoptosis quantitatively. However, we could not find clinically relevant substance for evaluation of apoptosis from this study Further study will be needed to establish a clinically useful severity scoring system evaluating both anoxic necrosis and apoptotis. Less