Two-hit Hypothesis and Multiple Organ Dysfunction Syndrome

Abstract

A severe insult in the form of infection or trauma primes the host immune system so that a subsequent,
relatively trivial insult produces a markedly exaggerated host immune response, which can lead
to multiple organ dysfunction syndrome (MODS) and death. This forms the basis of the “two-hit
hypothesis†(THH), which is being increasingly recognised as an important cause of morbidity and
mortality following severe injury and sepsis, particularly in intensive care settings. Appreciation of
the impact ofrepeatedinsults andpathophysiology of MODS is vital in the prevention of this serious
complication. We describe a case which illustrates the concept of THH and MODS and present a
review of literature on this subject.
Key words: laparotomy, multiple organ dysfunction, sepsis, two-hit hypothesis