Multiple organ dysfunction syndrome in bone marrow transplantation
W. D. Haire, E. I. Ruby, B. G. Gordon, K. D. Patil, L. C. Stephens, G. D. Kotulak, E. C. Reed, J. M. Vose, P. J. Bierman, A. Kessinger and al. et
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3330, USA.
OBJECTIVE--To define the frequency and outcome of organ dysfunction in bone
marrow transplantation (BMT) and to determine if patients with organ
dysfunction have lower levels of protein C (PC) and/or antithrombin III
(ATIII) than those without organ dysfunction. DESIGN--Inception cohort of
patients undergoing BMT, followed for 28 days, until hospital dismissal, or
until death. SETTING--Bone marrow transplant department of a university
hospital. PATIENTS--A total of 199 consecutive patients admitted for BMT.
INTERVENTIONS--Standard supportive care was given to all patients. MAIN
OUTCOME MEASURES--Definitions of organ dysfunction were arrived at prior to
beginning the study. They include pulmonary, central nervous system (CNS),
hepatic, and renal dysfunction. Protein C and ATIII levels were measured
prior to beginning the preparative regimen and weekly thereafter.
RESULTS--Single organ dysfunction, manifesting as pulmonary, CNS, or
hepatic dysfunction, occurred in 93 (48.5%) of the 199 patients and was a
strong predictor of multiple organ dysfunction syndrome (MODS) and death.
Death occurred in 14 (7.0%) of the patients. Cause of death was precisely
identified in only four patients. Low levels of either PC or ATIII were
associated with death and pulmonary, CNS, and hepatic dysfunction.
Multivariate analysis showed ATIII and PC levels were associated with
single organ dysfunction independent of the type of transplant, the type of
preparative regimen, and the presence of bacteremia. CONCLUSIONS--Single
organ dysfunction during BMT is a marker for a systemic abnormality that
has a high likelihood of progressing to MODS, similar to that seen in other
critically ill patient populations. MODS is the leading cause of death in
series of BMT patients. Low levels of ATIII and PC are markers of and may
be involved in the pathogenesis of MODS in BMT.
