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Purpose <p>The decision to delay secondary, non-life-saving orthopedic surgery to reduce the risk of multiple organ failure (MOF) or sepsis is largely based on expert opinion. A decision-making tool may solve this problem by pre-operatively reflecting the patient’s inflammatory/coagulation status. We aimed to determine whether the combination of readily available measures of inflammation and coagulation could predict MOF/sepsis in polytrauma patients.</p> Methods <p>We conducted a prospective single-center study of adult trauma patients requiring pelvic/acetabular surgery. Patients were recruited from October 2011–January 2018. The primary outcome was postoperative MOF and sepsis. Full blood count, prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen, complement C3 and C4, C-reactive protein, tryptase, cortisol, and interleukin-6 were collected preoperatively and 30&#xa0;min, 1&#xa0;day, and 3 days postoperatively. Principal component analysis (PCA) was used to cluster the data within and across time. Logistic regression was used to predict MOF or sepsis using the top 4 principal components.</p> Results <p>A total of 157 patients were recruited. The incidence of MOF and sepsis was 7% and 13%, respectively. PCA of preoperatively-collected immune and coagulation markers predicted MOF (area under the curve [AUC]: 0.94). Using routine tests alone predicted MOF with an AUC of 0.94. Sepsis was predictable with less accuracy than MOF from PCA (preoperative-AUC: 0.76).</p> Conclusion <p>The routine clinical data available prior to non-life-saving definitive pelvic/acetabular surgery could predict MOF, and may serve as a tool for orthopedic surgeons to optimise the timing of surgery. Multi-centre, prospective investigation is required for validation.</p>

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Predicting multiple organ failure after major orthopedic interventions is possible using only conventional laboratory tests

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Gabrielle D. Briggs,
  • Scott Gelzinnis,
  • Natalie J. Lott,
  • Eszter Tuboly,
  • James T. Coulthard,
  • Erin K. Nolan,
  • Christopher J. Oldmeadow,
  • Theo De Malmanche,
  • Zsolt J. Balogh

摘要

Purpose

The decision to delay secondary, non-life-saving orthopedic surgery to reduce the risk of multiple organ failure (MOF) or sepsis is largely based on expert opinion. A decision-making tool may solve this problem by pre-operatively reflecting the patient’s inflammatory/coagulation status. We aimed to determine whether the combination of readily available measures of inflammation and coagulation could predict MOF/sepsis in polytrauma patients.

Methods

We conducted a prospective single-center study of adult trauma patients requiring pelvic/acetabular surgery. Patients were recruited from October 2011–January 2018. The primary outcome was postoperative MOF and sepsis. Full blood count, prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen, complement C3 and C4, C-reactive protein, tryptase, cortisol, and interleukin-6 were collected preoperatively and 30 min, 1 day, and 3 days postoperatively. Principal component analysis (PCA) was used to cluster the data within and across time. Logistic regression was used to predict MOF or sepsis using the top 4 principal components.

Results

A total of 157 patients were recruited. The incidence of MOF and sepsis was 7% and 13%, respectively. PCA of preoperatively-collected immune and coagulation markers predicted MOF (area under the curve [AUC]: 0.94). Using routine tests alone predicted MOF with an AUC of 0.94. Sepsis was predictable with less accuracy than MOF from PCA (preoperative-AUC: 0.76).

Conclusion

The routine clinical data available prior to non-life-saving definitive pelvic/acetabular surgery could predict MOF, and may serve as a tool for orthopedic surgeons to optimise the timing of surgery. Multi-centre, prospective investigation is required for validation.