Multiple organ involvement and failure: selected Russian radiation accident cases re-visited

Abstract

In this paper we analyse the role of multi-organ failure (MOF) syndrome in the cause of death of victims with severe and very severe (>10 Gy) forms of accidental acute radiation syndrome (ARS). From 1958-1997 we have followed and managed 11 patients with gamma-neutron (criticalities), gamma-beta (Chernobyl) and pure gamma whole body irradiation. We describe three types of MOF following high dose irradiation: an early syndrome, when the total dose is more than 20 Gy, related to damage to the microcirculation and leakage syndrome; MOF as a consequence of severe radiation burns, followed by kidney failure and encephalopathy; and late MOF (2-3 months after 10 Gy or more total dose) due to the irradiation itself, to infection and to iatrogenic problems. All three types of MOF are potentially fatal and play an essential role in the pathogenesis of severe ARS.