Trauma is still the major cause of death and severe disabilities both in developing and industrialized countries. Severe trauma promotes a hyperinflammatory condition able to lead to a condition of organ(s) dysfunction known as multiple organ dysfunction syndrome (MODS), which in a continuum might end to multiple organ failure (MOF) and in worst cases death. Opposite inflammatory and anti-inflammatory responses are simultaneously present after trauma, leading to (multiple) organ dysfunction(s). The definition of MOF is still a matter of debate, and scores to grade its severity (MODS, SOFA, Denver score) are used with quite different results according to their sensibility and specificity. Harmonization of the scores and shared definitions appears mandatory to overcome this problem. Risk factors for MOF are male sex, age, obesity, severity of injury, units of red blood cells (RBCs) transfused within the first 12 h, and acidosis. As for infections, in trauma innate and adaptive responses are triggered by alarmins and damage-associated molecular patterns (DAMPs), recognized by components of innate and acquired immunity (mainly Toll-like receptors, TLRs): TLRs are able to transduce signals in response to alarmins and DAMPs and to activate several signal pathways, making these molecules the possible link between SIRS, inflammation, and trauma. Prevention of major dysfunctions of the cardiovascular, respiratory, and renal systems remains the mainstay strategy, mainly based on early, adequate, aggressive supportive measures.
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