Intestinal platelet trapping after traumatic and septic shock. An early sign of sepsis and multiorgan failure in critically ill patients?
OBJECTIVES: Patients resuscitated after severe traumatic or septic shock were studied with reference to the behavior of radiolabeled platelets in vital organs, the occurrence of sepsis, and multiorgan failure. These findings were compared with findings of patients who had sustained severe head trauma, but had reportedly not been in shock. DESIGN: Prospective, clinical trial of consecutive patients. SETTING: Multidisciplinary ICU. PATIENTS: Thirteen critically ill patients who were considered at high risk for developing multiorgan failure. These patients had all been resuscitated after major trauma (Injury Severity Score 50.2 +/- 7.2) or severe septic shock (group A, Acute Physiology and Chronic Health Evaluation [APACHE II] score 21.7 +/- 4.4). For comparison, six patients with head trauma, who were considered at low risk for multiorgan failure were studied (group B, Injury Severity Score 26.0 +/- 5.1 and APACHE II score 12.3 +/- 2.4). MEASUREMENTS: Platelet trapping was studied in multiple organs by external detection of platelets labeled with 111indium-oxine. Measurements were started on the third day and continued for seven consecutive days or until death. RESULTS: Eight of 13 patients in group A developed sepsis and multiorgan failure and six of these eight patients died 8 to 29 days after the initial insult. No patient in group B developed multiorgan failure, and all survived. The patients in group A had significant increases in platelet trapping in the liver and the lungs, but the increase was significantly (p less than .01) greater in the nonsurvivors than in the survivors. All the nonsurvivors had markedly increased platelets sequestration in the intestine (less than 10 times the activity in blood), but none of the survivors had increased platelet sequestration in the intestine (p less than .01). This increase was recorded 1 to 4 days before the first clinical signs of sepsis and 3 to 7 days before the development of multiorgan failure. No patient in group B had increased activity in the liver or in the intestine, and only one patient had a slight increase in the lung. CONCLUSIONS: The results indicate that, in patients resuscitated after severe traumatic or septic shock, increased sequestration of platelets in the intestine, as measured by external detection of radioisotope-labeled autologous platelets, may precede clinical signs of sepsis and multiorgan failure and may possibly predict the outcome.