Blood Biomarkers Signal Multiple Organ Dysfunction Syndrome After Critical Injuries Interview with:

Dr. Joanna Shepherd Centre for Trauma Sciences Blizard Institute Queen Mary, University of London

Dr. Shepherd

Dr. Joanna Shepherd
Centre for Trauma Sciences
Blizard Institute
Queen Mary, University of London What is the background for this study? What are the main findings?

Response: Recent advances in resuscitation and treatment of life-threatening critical injuries means that patients with previously unsurvivable injuries are now surviving to reach hospital.  However, many of these patients develop Multiple Organ Dysfunction Syndrome (MODS), which is a failure of several organs including the lung, heart, kidney, and liver.

We studied immune cell genes in the blood of critically injured patients within the first few minutes to hours after injury, a period called the ‘hyperacute window’. We found a small and specific response to critical injury during this window that then evolved into a widespread immune reaction by 24 hours.  The development of MODS was linked to changes in the hyperacute window, with central roles for innate immune cells (including natural killer cells and neutrophils) and biological pathways associated with cell death and survival.  By 24 hours after injury, there was widespread immune activation present in all critically injured patients, but the MODS signal had either reversed or disappeared. What should clinicians and patients take away from your report?

Response: The first few minutes to hours after injury is a pivotal period for understanding how the immune reaction evolves after critical injury and how it may lead to MODS.  This hyperacute window is challenging to study due to the logistics of doing research in the emergency setting.  However, by identifying key changes that lead to MODS during this early window, there may be an opportunity to modify it course and improve outcomes for patients.  Understanding the human hyperacute response of the clotting system changed an entire resuscitation paradigm within a decade. It is possible that understanding the hyperacute immune response will do the same for our approach to organ dysfunction and protection. What recommendations do you have for future research as a result of this study?

Response:  Our findings provide opportunities to change the way we diagnose and treat patients at risk of developing MODS.  Further research is required to validate our findings in larger cohorts of patients.  In the future, therapies could be developed to target the hyperacute window, and protect organs from the effects of potentially damaging biological pathways.  If we could detect a genetic ‘signature’ for MODS from a patient’s immune cells immediately after injury, then this could be used to tailor treatment to their individual needs.

Disclosures: Professor Brohi, who led this research team, is a member of the Editorial Board of PLoS Medicine and served as guest editor on PLoS Medicine’s Special Issue on Trauma.” Thank you for your contribution to the community.

Citation: Signatures of inflammation and impending multiple organ dysfunction in the hyperacute phase of trauma: A prospective cohort study

Claudia P. Cabrera ,Joanna Manson ,Joanna M. Shepherd  ,Hew D. Torrance,David Watson,M. Paula Longhi,Mimoza Hoti,Minal B. Patel,Michael O’Dwyer,Sussan Nourshargh,Daniel J. Pennington,Michael R. Barnes,Karim Brohi

PLO Medicine Published: July 17, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.




Last Updated on July 27, 2017 by Marie Benz MD FAAD