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Inflammatory serum markers in patients with multiple trauma. Can they predict outcome?

Clinical trials have provided information concerning the various immunological alterations that occur after trauma which may cause the multiple organ dysfunction syndrome (MODS) and death. Once multiple systems are dysfunctional the rates of mortality are as high as 50%, the morbidity is severe and the costs of health care are enormous. 1,2 Although external support such as ventilators, dialysis machines and inotropic drugs, is provided to all patients to compensate for the internal dysfunction until they can support themselves, the end result is often unpredictable. Early evaluation of the prognosis in polytraumatised patients is difficult. Traditionally, the clinical condition and management of the patient are assessed by evaluation of cardiovascular, renal, liver and respiratory functions. Nevertheless, the significance of such clinical parameters as the urinary output, oxygen saturation, blood gases, C-reactive protein, base excess, etc, is limited since only patients with a clearly impaired organ function can be distinguished. Organ dysfunction which is not detectable by these parameters does not guarantee a condition of the patient which is stable enough for operation especially if in the ‘borderline condition’. 3