Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II score compared with trauma scores in the outcome of multiple-trauma patients

Background

Prospective data regarding the prognostic value of the Sequential Organ Failure Assessment (SOFA) score in comparison with the Simplified Acute Physiology Score (SAPS II) and trauma scores on the outcome of multiple-trauma patients are lacking.

Methods

Single-center evaluation (n = 237, Injury Severity Score [ISS] >16; mean ISS = 29). Uni- and multivariate analysis of SAPS II, SOFA, revised trauma, polytrauma, and trauma and ISS scores (TRISS) was performed.

Results

The 30-day mortality was 22.8% (n = 54). SOFA day 1 was significantly higher in nonsurvivors compared with survivors (P < .001) and correlated well with the length of intensive care unit stay (r = .50, P < .001). Logistic regression revealed SAPS II to have the best predictive value of 30-day mortality (area under the receiver operating characteristic = .86 ± .03). The SOFA score significantly added prognostic information with regard to mortality to both SAPS II and TRISS.

Conclusions

The combination of critically ill and trauma scores may increase the accuracy of mortality prediction in multiple-trauma patients.     

Utility of Sequential Organ Failure Assessment score in predicting bacteremia in critically ill burn patients

Background

We evaluated whether qSOFA ≥2 and an increase in SOFA (ΔSOFA) ≥2 can help predict bacteremia in a critically ill burn population.

Age,microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis

Background and aims  Tertiary peritonitis is a severe persisting intra-abdominal infection and associated with high mortality. The aim was to find significant risk factors for mortality and tertiary peritonitis including the Mannheim Peritonitis Index (MPI), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and a sumscore of both. Materials and methods  In this retrospective single-center cohort study, 122 patients were treated at the Surgical Department of a University Hospital. Results  Sixty-nine patients (56.6%) developed tertiary peritonitis. Nineteen patients (27.5%), who suffered from tertiary peritonitis, died in contrast to eight patients (15.1%) with secondary peritonitis (P = 0.101). Patients with tertiary peritonitis had significantly higher APACHE II (P < 0.001), MPI (P = 0.035), and combined APACHE II and MPI scores (P < 0.001) than patients with secondary peritonitis. Age (P = 0.035), fungal infections (P = 0.025), and infections with more than one microbial organism (P = 0.047) were predictive for tertiary peritonitis. Combined APACHE II and MPI scores detected tertiary peritonitis better than the MPI (P = 0.014). Detection of mortality was comparable in all evaluated prognostic scores. Conclusion  Prognostic scores besides age and fungal infections are risk factors for mortality and help to differentiate between secondary and tertiary peritonitis. The combination of prognostic scores is comparable to the APACHE II and superior compared to the MPI in regard to detection of tertiary peritonitis. Presented in part to the 19th European Congress on Surgical Infections of the Surgical Infection Society-Europe (SIS-E), Athens, Greece, May 2006.     

血浆置换、血液灌流联合连续性肾脏替代治疗蜂蛰伤致多器官功能损伤的研究

目的：观察对比血液灌流联合连续性肾脏替代治疗（ CRRT）与血浆置换、血液灌流联合CRRT对胡蜂蛰伤致多器官功能损伤的临床疗效。方法将2008年8月～2013年10月来本院就诊的胡蜂蛰伤致多器官功能损伤者72例,根据患者经济情况及意愿分为两组（两组患者一般资料具有均衡性）,对照组（35例）行血液灌流联合CRRT,实验组（37例）行血浆置换、血液灌流联合 CRRT,观察记录两组患者治疗前后生化指标、并发症和病死率、治愈率以及平均住院天数的情况。结果实验组患者各项生化指标明显改善,并优于对照组（ P ＜0．05）,具有更少的临床并发症、较低的病死率以及更高的治愈率,缩短了住院时间（ P ＜0．05）。结论血浆置换、血液灌流联合CRRT能更有效治疗蜂蛰伤致多器官功能损伤,值得临床推广应用。     

影响MODS合并AKI患者预后的相关因素分析

目的 探讨影响多器官功能障碍综合征(MODS)合并急性肾损伤(AKI)患者预后的相关因素.方法 回顾性分析本院收治的101例MODS合并AKI患者的临床资料,根据其住院期间预后分为死亡组和好转组,比较两组影响因素的差异,采用多因素Logistic回归分析影响预后的因素.结果 101例患者中总死亡例数为55例(54.5％).AKIⅢ期的病死率明显高于AKI Ⅰ期和AKIⅡ期(x2=5.541,3.856,P＜0.05).与AKI Ⅰ期相比,AKIⅡ期、AKIⅢ期患者的APACHEⅡ评分、SOFA评分、器官衰竭数、机械通气率、血管活性药物使用率均明显升高(P＜0.05);与AKIⅡ期相比,AKIⅢ期患者的以上指标也明显升高(P＜0.05).多因素Logis-tic回归分析显示APACHEⅡ评分、器官衰竭数、机械通气率是M明显升高(P＜0.05).与好转组相比,死亡组的年龄、APACHEⅡ评分、SOFA评分、器官衰竭数、机械通气率、血管活性药物使用率均明显升高(P＜0.05),ODS合并AKI的危险因素.结论 MODS合并AKI患者的预后受到多个因素的影响,APACHEⅡ评分、器官衰竭数、机械通气率是其主要危险因素.     

Circulating Inflammatory and Metabolic Parameters to Predict Organ Failure after Muliple Trauma

Background: Patients encountering severe trauma are at high risk of sequential organ complications. We studied the value of circulating inflammatory mediators and metabolic parameters to evaluate their predictive value with respect to the development of multiple organ failure (MOF). Patients and Methods: In 77 traumatized patients with a mean Injury Severity Score (ISS) of 28.8±1.1 points, C-reactive protein (CRP), polymorphonuclear (PMN) elastase, lactate, interleukin-6 (IL-6), IL-8, and soluble tumor necrosis factor receptors 1 and 2 (TNF-R1 and TNF-R2) were determined for a period of 11 days following multiple trauma. Results: Weak and moderate correlations were found between mean plasma concentrations of all parameters and mean MOF scores calculated from the whole observation period [range: lactate (r=0.31, p < 0.01) to TNF-R1 (r=0.53, p < 0.001)]. Daily TNF-R1 and lactate concentrations of the 1st week moderately correlated with mean MOF scores of the 2nd week (p < 0.01). ISS weakly correlated with all parameters exept lactate [range: IL-8 (r=0.27, p < 0.05) and PMN elastase (r=0.46, p < 0.001)]. Prediction of MOF could not be improved by inclusion of several or all investigated mediators into multiple regression models. Conclusion: Only early plasma TNF-R1 and blood lactate concentrations showed a moderate association with the development of late posttraumatic organ failure. Thus, the predictive role of inflammatory mediators with respect to the manifestation of organ dysfunction after severe trauma seems limited. Received: October 23, 2002; revision accepted: November 12, 2002 Correspondence Address Johannes Frank, MD, Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe University Medical School, 60590 Frankfurt/Main, Germany, Phone (+49/69) 6301-5069, Fax -6439, e-mail: j.frank@trauma.uni-frankfurt.de     

多脏器功能障碍综合征患者连续性血液净化的效果

目的 探讨连续性血液净化（CBP）用于多脏器功能障碍综合征（MODS）患者的效果。方法 MODS患者20例，男性13例，女性7例，年龄40—87岁，ASA分级Ⅱ级7例、Ⅲ级13例，均符合MODS和急性呼吸窘迫综合征的诊断标准。经右侧股静脉置管，使用持续性肾脏替代治疗机以高容量连续性静脉．静脉血液滤过（HV—CVVH）模式治疗。于第1次CBP前、CBP开始后2、4、6h及CBP停止后6h测定心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、pH、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2／FiO2）、肺动态顺应性（Cdyn）、气道阻力（Raw），同时抽取静脉血2ml测定血液BUN、Scr、Glu、Na^＋、K^＋、Cl^-的浓度。结果 与第1次CBP前比较，pH、PaCO2、Na^＋、Cl^-、G1u差异无统计学意义（P〉0．05）；PaO2、PaO2／FiO2和Cdyn在CBP开始后2、4、6h时明显升高（P〈0．05）；Raw、BUN、Scr和K^＋明显降低（P〈0．05）；HR于CBP开始后2、4、6h以及CBP停止后6h时降低（P〈0．05）。结论 CBP能促进MODS患者的氧合功能，改善血液生化指标，维持内环境稳定，对血液动力学无明显影响。     

Extracorporeal Detoxification for Hepatic Failure Using Molecular Adsorbent Recirculating System: Depurative Efficiency and Clinical Results in a Long‐Term Follow‐Up

Acute liver failure and acute‐on‐chronic liver failure still show a poor prognosis. The molecular adsorbent recirculating system (MARS) has been extensively used as the most promising detoxifying therapy for patients with these conditions. Sixty‐four patients with life‐threatening liver failure were selected, and 269 MARS treatments were carried out as a bridge for orthotopic liver transplantation (OLT) or for liver function recovery. All patients were grouped according to the aim of MARS therapy. Group A consisted of 47 patients treated for liver function recovery (median age 59 years, range 23–82). Group B consisted of 11 patients on the waiting list who underwent OLT (median age 47 years, range 32–62). Group C consisted of 6 patients on the waiting list who did not undergo OLT (median age 45.5 years, range 36–54, P = 0.001). MARS depurative efficiency in terms of liver toxins, cytokines, and growth factors was assessed together with the clinical outcome of the patients during a 1‐year follow‐up. Total bilirubin reduction rate per session (RRs) for each MARS session was 23% (range 17–29); direct bilirubin RRs was 28% (21–35), and indirect bilirubin RRs was 8% (3–21). Ammonia RRs was 34% (12–86). Conjugated cholic acid RRs was 58% (48–61); chenodeoxycholic acid RRs was 34% (18–48). No differences were found between groups. Hepatocyte growth factor (HGF) values on starting MARS were 4.1 ng/mL (1.9–7.9) versus 7.9 ng/mL (3.2–14.1) at MARS end (P < 0.01). Cox regression analysis to determine the risk factors predicting patient outcomes showed that age, male gender, and Sequential Organ Failure Assessment score (but not Model for End‐stage Liver Disease score) were factors predicting death, whereas the number of MARS sessions and the ΔHGF proved protective factors. Kaplan–Meier survival analysis was also used; after 12 months, 21.3% of patients in Group A survived, while 90.9% were alive in Group B and 16.7% in Group C (log rank = 0.002). In conclusion, MARS was clinically well tolerated by all patients and significantly reduced hepatic toxins. Better survival rates were linked to an OLT program, but patients' clinical characteristics on starting MARS therapy were the main factors predicting survival. The role of HGF should be evaluated in larger clinical trials.     

Secular trends in mortality associated with new therapeutic strategies in surgical critical illness

BACKGROUND: Since 1999 randomized controlled trials have shown that new therapeutic strategies, such as strict glycemic control, increased use of noninvasive ventilation and of lung-protective ventilation, and early goal-oriented shock therapy, may reduce mortality in selected groups of critically ill patients. Whether these benefits can be translated to a surgical clinical setting is unclear. We wanted to evaluate longitudinally the successive routine implementation of new therapeutic measures and its effect on postsurgical patients admitted to the intensive care unit. METHODS: We performed a retrospective analysis on data collected prospectively from March 1, 1993 through February 28, 2005. RESULTS: A cohort of 1,802 consecutive cases requiring intensive care therapy for more than 4 days was analyzed. A significant decrease in mortality was observed in the last years of the study. With adjustment for relevant covariates, treatment after the implementation of new therapeutic strategies was identified as an independent factor linked with a reduced risk of death (odds ratio [OR] .518; 95% confidence interval [CI] .337-.796), whereas older age (OR 1.030; 95% CI 1.015-1.045), a high severity score on admission (OR 1.155; 95% CI 1.113-1.198) or during intensive care unit stay (OR 1.187; 95% CI 1.145-1.231), a high number of failing organs (OR 1.918; 95% CI 1.635-2.250), and peritonitis (OR 3.277; 95% CI 2.046-5.246) were independently associated with death. CONCLUSIONS: Implementing of a variety of new therapeutic measures into routine care of critically ill surgical patients was associated with improved survival after 2001.     

Pseudomonas peritonitis in CAPD patients: characteristics and outcome of treatment

Twenty-five episodes of Pseudomonas peritonitis which occurred over a five-and-a-half-year period were reviewed. Pseudomonas peritonitis accounted for 25/516 (4.8%) of all episodes of peritonitis. Nine of the episodes were first infections in that the patient had not experienced peritonitis before. The rest were repeat peritonitis. There was no difference in any demographic factors between the first episodes and the repeat episodes except exit site infection which was more common among patients who had repeat infections. Overall cure rate of Pseudomonas peritonitis was 20/25 (80%). Five catheters had to be removed, all in patients who had to be transferred permanently to haemodialysis. In general, ceftazidime in combination with an aminoglycoside was an effective regimen. Oral ofloxacin was not useful despite in vitro sensitivity of the pathogen to the antibiotic.     

高容量血液滤过治疗多器官功能障碍综合征的分析

目的研究高容量血液滤过 (HVHF)在多器官功能障碍综合征 (MODS)治疗中的作用。方法 19例MODS患者 ,随机选择 10例行HVHF ,另 9例行常规连续性静脉 静脉血液滤过 (CVVH)。于治疗前和治疗开始后 2、4、8h动脉采血 ,检测血气、血肌酐 (Scr)、尿素氮 (BUN)、肿瘤坏死因子(TNFα)、白细胞介素 1(IL 1β)、白细胞介素 6 (IL 6 )的变化。 结果HVHF组与CVVH组于治疗开始后4h血Scr、BUN均显著下降 ,肾功能改善。HVHF组血TNFα、IL 1β、IL 6治疗前分别为 ( 1795± 5 0 6 )ng/L、( 96 4± 185 )ng/L、( 1332± 4 15 )ng/L ,治疗开始后 4h为 ( 12 6 5± 397)ng/L、( 5 11± 12 4 )ng/L、( 72 6±2 4 3)ng/L ,差异有显著意义 ,P <0 0 5。CVVH组血TNFα治疗前为 ( 1799± 5 11)ng/L ,治疗开始后 4h为 ( 132 7± 4 2 1)ng/L ,差异有显著意义 ,P <0 0 5。HVHF组死亡 3例 ( 3/ 10 ) ,CVVH组死亡 5例 ( 5 / 9) ,差异有显著意义 ,P <0 0 5。结论HVHF可通过对流和AN6 9膜的吸附作用清除大量炎症介质 ,改善MODS患者的预后     

急性颈髓损伤并发MSOF的类型及原因分析

目的：通过探讨急性颈椎颈髓损伤并发多系统器官衰竭（ｍｕｌｔｉｐｌｅｓｙｓｔｅｍｏｒｇａｎｆａｉｌｕｒｅ，ＭＳＯＦ）发病因素及其类型，为防治伤后ＭＳＯＦ提供依据。方法：对我院１９８２年１月～１９９７年５月收治的３０３例急性外伤性颈椎颈髓损伤并发ＭＳＯＦ的３２例病人进行回顾性分析。结果：颈髓损伤并发ＭＳＯＦ的诱因为肺部感染，高热，水电解质平衡紊乱，低蛋白血症和术后继发性颈髓损害。ＭＳＯＦ的发生率为颈髓损伤病人１０．５６％，死亡２５例，死亡率为ＭＳＯＦ病人７８．１３％。结论：消除ＭＳＯＦ的诱因并对可能发生或已发生功能不全的器官进行有效的功能支持，才能降低颈髓损伤后ＭＳＯＦ的发生率、死亡率     

Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients

BACKGROUND: Acute acalculous cholecystitis (AAC) refers to cholecystitis without gallstones and is a serious complication of critical illness. We describe the time course of organ system dysfunction associated with cholecystectomy in critically ill patients with AAC. METHODS: The data of all intensive care unit (ICU) patients who had operatively confirmed AAC during their ICU stay between 2003 and 2004 were analyzed. Patients who also had other intra-abdominal pathologies were excluded. The Sequential Organ Failure Assessment (SOFA) scores were recorded 3 days before, on the day of operation and on the first, second, third and seventh post-operative day after cholecystectomy. The impact of open cholecystectomy on organ dysfunction was evaluated on the basis of the change in the total and individual organ SOFA scores. RESULTS: Twenty-four patients underwent open cholecystectomy for AAC with no other intra-abdominal pathology. Sepsis was the most common admission diagnosis, followed by cardiovascular surgery. The mean (standard deviation, SD) Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS) II and SOFA scores on admission were 24.7 (5.8), 44.3 (12.3) and 9.4 (3.2), respectively. The median (25th, 75th percentiles) total SOFA score 3 days before cholecystectomy was 7.5 (1.3, 8.0), which increased to 10.5 (8.3, 13.0) (P < 0.0001) by the day of cholecystectomy, indicating developing multiorgan dysfunction. After the operation, the score decreased to 5.5 (3.3, 10.8) (P = 0.004) by the seventh post-operative day. The change was most obvious in cardiovascular and respiratory SOFA scores. CONCLUSIONS: AAC is associated with multiorgan dysfunction in critically ill patients. Open cholecystectomy seems to alter the course of multiorgan dysfunction in these patients.     

全身炎症反应综合征与多器官功能障碍综合征的临床研究

作者前瞻性调查了２３０例危重病患者,根据危重病患者全身性炎症反应综合征（ＳＩＲＳ）和多器官功能障碍综合征（ＭＯＤＳ）的症状,分析ＳＩＲＳ到ＭＯＤＳ的渐进发展过程,探讨治疗策略。结果显示：患者转入加强医疗病房（ＩＣＵ）时,ＳＩＲＳ患病率７１．３％,病死率１８．９％。２３０例患者中,６５例发生ＭＯＤＳ（２８．３％）,死亡３３例（５０．８％）。非感染性ＳＩＲＳ、全身性感染及感染性休克患者的ＭＯＤＳ患病率依次为２２．８％,６１．１％和８５．７％,而病死率依次为１１．４％,３０．６％和５０．０％。作者认为,早期诊断ＳＩＲＳ,并积极调控机体炎症反应,可能是改善危重患者预后的关键。     

HSP-70基因转染对脓毒症大鼠并发多脏器衰竭的保护作用

目的探讨脓毒症并发多脏器功能不全时HSP 70对重要脏器的保护作用。方法通过盲肠结扎穿孔 (cecalligationpuncture ,CLP)建立脓毒症大鼠模型并转染HSP 70基因 ,分析HSP 70基因转染前后细胞因子、多脏器功能与形态的变化。结果CLP组 ,血清TNF α、IL 6、IL 1β、IL 10的浓度分别在 6、12、2 4、4 8h与对照组相比显著升高 (tTNF α=16 5 0 6 ;tIL 6=33 977;tIL 1β=2 2 5 36 ;tIL 10 =15 0 5 6 ;P <0 0 1) ;4 8h的心、肝、肾功能血生化指标与对照值相比出现显著改变 (tLDH=7 5 15 ;tALP=8 316 ;tCr=8 990 ;P <0 0 1) ;形态学上肺组织存在明显损伤。HSP 70基因转染组 ,细胞因子、多脏器功能与形态没有发生明显变化。结论HSP 70基因转染对CLP后心、肝、肺、肾具有明显保护作用 ,对于防治脓毒症及早期并发的多脏器功能不全具有潜在重要的临床应用价值。     

Aetiology and outcome of acute renal failure secondary to war related trauma and infectious disease in Croatia

Summary: The aim of our study was to explore the aetiology and the outcome of acute renal failure (ARF) during the war in Croatia. of the 2132 patients admitted to our hospital between April 1990 and November 1992 due to war related trauma, 11 (0.5%) developed ARF. We believe that the development of ARF in these patients was secondary to an overwhelming septic process. Most of our patients suffered from multiple organ failure. of the 11 patients suffering from ARF due to war related trauma only four recovered (63.6% had died). We attribute the lethal outcome to the progression of the septic process. Patients who developed ARF due to infectious diseases unrelated to trauma had a different prognosis. Acute renal failure caused by the Hantan virus ran a benign course, in both its oliguric and non-oliguric form. Patients who developed ARF as a complication of leptospirosis also had a good prognosis. Although ARF is usually of a multifactorial genesis, our study aimed to emphasize the importance of disseminated septic processes as a cause of ARF.     

胸部开放伤后海水浸泡致多器官功能障碍综合征

目的 探讨实验动物胸部开放伤后海水浸泡致多器官功能障碍（ＭＯＤＳ）的发生率和发生特点。方法 成年杂种犬致伤后随机分为对照组（单纯胸伤组,ｎ＝１０）和实验组（ｎ＝１０）。实验组动物于伤后置入人工配制的海水中。实验过程中动态监测血清丙氨酸氨基转移酶（ＡＬＴ）、门冬氨酸氨基转移酶（ＡＳＴ）、肌酸肌酶（ＣＫ）、乳酸脱氢酶（ＬＤＨ）、尿素氮（ＢＵＮ）和肌酐（Ｃｒ）以及肿瘤坏死因子α（ＴＮＦα）和白细胞介素１     

连续性血液净化治疗热射病合并多器官功能障碍的临床疗效

目的 探讨连续性血液净化（CBP）技术对热射病合并多器官功能障碍综合征（MODS）的临床疗效.方法 选择热射病合并MODS患者12例,观察CBP治疗前后体温、心率、平均动脉压（MAP）、血肌酐、尿素氮、谷丙转氨酶（ALT）、谷草转氨酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-Mb）的变化,计算急性生理学及慢性健康状况Ⅱ（APACHEⅡ）评分,检测CBP治疗前后血清肿瘤坏死因子α（TNF-α）和白细胞介素1β（IL-1β）的含量变化.结果 12例患者全部抢救成功,与治疗前比较,经CBP治疗12、24和48 h后,所有患者体温、心率、MAP均明显改善,APACHEⅡ评分均明显降低（均P＜0.05）;血肌酐、尿素氮、ALT、AST、CK、CK-Mb明显低于治疗前（均P＜0.05）;血清TNF-α和IL-1β水平也低于治疗前（均P＜0.05）.治疗中未出现任何不良反应.结论 CBP治疗能明显改善热射病合并MODS患者的肝肾功能,减轻心肌和骨骼肌损伤,清除体内炎症因子,稳定机体内环境,改善预后.     

重症急性胰腺炎早期脏器功能不全持续时间与治疗对策

目的探讨重症急性胰腺炎（severe acute pancreatitis,SAP）影响脏器功能不全持续时间的因素及其对患者转归的作用以及相应的治疗策略。方法2000年1月至2005年6月连续收治74例Ⅱ型SAP患者,按脏器功能不全持续时间分为两组：脏器功能不全持续时间≤3d,为暂时性脏器功能不全组（20例）;脏器功能不全持续时间〉3d,为持续性脏器功能不全组（54例）。比较两组患者在SAP并发症和病死率方面的差异。结果74例SAPⅡ型患者中,心血管系统功能不全发生率80％、肺脏47％、肝脏37％、肾脏20％;暂时性脏器功能不全组多脏器功能不全所占比例明显低于持续性脏器功能不全组（P〈0．01）。暂时陛脏器功能不全组并发症发生率和病死率明显低于持续性脏器功能不全组（P值分别为0．038和0．054）。结论脏器功能不全持续存在3d以上是预示SAP患者死亡的危险因素,避免脏器功能不全发生或缩短脏器功能不全的持续时间是改善SAP患者预后的关键。     

烧伤后多器官功能障碍综合征患者可溶性脂多糖受体CD14的变化

目的探讨可溶性脂多糖受体ＣＤ１４（ｓＣＤ１４）与严重烧伤后多器官功能障碍综合征（ＭＯＤＳ）发生、发展的关系及ｓＣＤ１４诱生的可能机制。方法烧伤总面积大于７０％患者２２例,其中并发ＭＯＤＳ者９例,非ＭＯＤＳ者１３例。分别于伤后２４小时、第３、７、１４、２１、２８天收集血标本,检测ｓＣＤ１４、内毒素及肿瘤坏死因子（ＴＮＦ）含量。结果大面积烧伤后第７天患者血清ｓＣＤ１４水平明显升高,且持续至伤后第３周。伤后第７、１４、２１天ＭＯＤＳ组血清ｓＣＤ１４水平显著高于非ＭＯＤＳ组（Ｐ＜００５）,其变化与循环内毒素呈显著正相关。同时,随着ｓＣＤ１４均值上升,患者死亡率亦逐渐增高。结论ｓＣＤ１４与严重烧伤后ＭＯＤＳ的发生、发展密切相关,动态监测其变化对ＭＯＤＳ的发生及病情转归具有一定的预警意义