Multiple organ failure can happen to a healthy person, say doctors

A key trigger of multiple organ failure in an otherwise healthy individual is sepsis, formerly referred to as “blood poisoning”. ST PHOTO: LIM YAOHUI

SINGAPORE – Multiple organ failure does not just strike people who are critically ill. It can also happen in healthy individuals, say doctors.

It can be caused by acute medical emergencies such as physical trauma from road accidents; severe burns and scalds; and intense poisoning.

“Such trauma triggers an extreme inflammatory response in the body. It activates the immune response to try to neutralise the danger, prevent infection, and initiate tissue repair,” said general surgeon with PanAsia Surgery Glenn Bonney.

This inflammation goes from a protective mechanism to a deadly threat that causes the body to lose its ability to regulate itself. More white blood cells are recruited to the affected area, triggering widespread damage.

“Paradoxically, this flood of inflammatory signals that the immune system releases damages vital organs, causing them to fail instead of being protected,” he said.

Andrew Hong Choon Chiet, who heads the Division of Foot and Ankle Surgery at the Department of Orthopaedic Surgery in National University Hospital (NUH), agreed.

“When multiple organ failure occurs in a patient with, say, an ankle fracture, it is usually related to other factors or complications rather than the fracture alone,” he said.

These may include severe, life-threatening injuries that are being treated in the intensive care unit, major blood loss, overwhelming infection leading to sepsis (blood poisoning), or serious medical complications such as a deep vein thrombosis (deep vein blood clot) leading to pulmonary embolism (blood clot in the lung).

“Surgery may contribute to certain risks, such as blood clot formation, but the injury itself, patient-related risk factors, reduced mobility, and pre-existing medical conditions also play important roles,” he added.

Teo Li-Tserng, director of Tan Tock Seng Hospital’s (TTSH) Trauma Centre, said: “Even in otherwise healthy individuals, the use of steroids, immunosuppressants, certain health supplements or traditional Chinese medicine (TCM) may increase the risk of developing multiple organ failure.”

Steroids and immunosuppressants, while calming overactive immune systems, tend to lower the body’s defences; and certain supplements or TCM, though generally safe, may be toxic when incorrect doses are used.

Said Tay Kae Sian, a consultant with the Department of Orthopaedic Surgery at Singapore General Hospital (SGH): “A patient can go from speaking comfortably to suffering sudden breathlessness, cardiac arrest, and profound organ oxygen deprivation within a matter of minutes.

“If the heart cannot be restarted quickly, widespread organ failure establishes itself within hours.”

A patient can go from speaking comfortably to suffering sudden breathlessness, cardiac arrest, and profound organ oxygen deprivation within a matter of minutes, ending up in the ICU. PHOTO: ST READER

A case in point is a former Singapore Airlines (SIA) stewardess who died suddenly on July 9 – about two weeks after she slipped and fractured her ankle. She underwent surgery on June 30 and had seemed to be recovering well before she collapsed and could not be resuscitated.

The cause of death was reportedly multi-organ failure following pulmonary thromboembolism, a sudden blockage of an artery in the lungs, which is almost always caused by a blood clot that forms in a deep vein.

Muhd Farhan Mohd Fadil, who heads the Department of Orthopaedic Surgery at TTSH, told ST that while surgery to repair fractures does not cause the pulmonary thromboembolism, “the injury itself and the period of immobilisation may increase the risk”.

“Depending on the severity of the clot, multiple organ failure can develop within a day of diagnosis,” his colleague Teo said.

The blood clot obstructs critical blood vessels, cutting off the supply of oxygen and nutrients. This “starvation” triggers a systemic inflammatory response, ultimately causing multiple organs to rapidly shut down.

According to Teo, a trauma surgeon, once pulmonary thromboembolism is suspected, an urgent CT pulmonary angiogram should be performed to confirm the diagnosis.

If large clots are detected, they are removed either using specialised catheter-based techniques or surgery, followed by anticlotting therapy. But if the clots are small, blood thinners can be given to prevent further clot formation, reduce damage to the lungs and minimise strain on the heart.

Sepsis, the silent killer

A key trigger of multiple organ failure in an otherwise healthy individual is sepsis, formerly referred to as “blood poisoning”. Common infections that trigger sepsis include urinary tract infection (UTI), and skin wounds.

In Singapore, sepsis is a leading cause of medical emergencies and a major contributor to death. About 15 out of every 1,000 hospitalised patients develop sepsis, accounting for about 5,000 deaths yearly.

According to Annals Singapore, a medical journal published by the Academy of Medicine, an estimated 17 to 20 per cent of all deaths in the country have been linked to sepsis complications.

Bonney said the symptoms of sepsis, such as shivering, fever, or breathlessness, can mimic common illnesses, and are often overlooked.

“However, should someone with a common infection like UTI display none of its typical symptoms such as a strong urge to urinate, a burning sensation when passing urine and frequently urinating small amounts, it is easy to miss until it becomes a medical emergency,” he said.

He said that is when the bacteria successfully multiply and invade the bloodstream from the kidneys and the resulting inflammation rapidly causes the other organs to fail. It can be fatal if not treated aggressively and in time, he said.

While some patients recover fully from multi-organ shutdown, others may experience long-term effects involving the lungs, heart, kidneys, nervous system, or physical functioning. PHOTO: COURTESY OF TAN TOCK SENG

Tay from SGH said when it comes to a fracture that is open and becomes severely infected, that is when bacteria enter the bloodstream.

“This can lead to sepsis, an overwhelming immune response that causes widespread inflammation, microscopic blood clots, a drastic drop in blood pressure, and subsequent multiple organ failure,” he said.

While some patients recover fully from multi-organ shutdown, others may experience long-term effects involving the lungs, heart, kidneys, nervous system, or physical functioning.

Hong said: “Recovery can take weeks to months and may require rehabilitation and ongoing medical follow-up. The prognosis varies greatly depending on the patient’s age, overall health, and the number of organs affected.”

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