Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome

Abstract

IntroductionRecognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome.MethodsUsing the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score.ResultsA total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, P < 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors.ConclusionsEarly changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis.

Pulmonary complications after non-cardiac surgeries: temporal patterns and risk factors

“…The Sequential Organ Failure Assessment (SOFA) score is a tool developed to quantitatively describe the time course of organ dysfunction [14]. A previous study found that the SOFA score was an independent predictor of developing early acute respiratory failure in a heterogeneous population of critically ill patients [21]. Our data suggest that a 10% increase in the risk of POPCs is likely for each unit increase in the SOFA score at ICU admission.…”

Intensive Care Unit without walls: Seeking patient safety by improving the efficiency of the system

“…3,10,11 As an example, Cardoso et al 11 have reported that each hour of delay in admission of a patient to the ICU is associated with a 1.5% increase in the risk of death in the ICU and a 1% increase in Hospital mortality. Likewise, Sakr et al 12 have found mortality among critically ill patients to be clearly related to the initial evolution of organ failure and the SOFA score at the time of admission to the ICU. If readmission to the ICU proves necessary, there is a four-fold increase in mortality risk, and the length of Hospital stay is moreover doubled.…”

Supranormal Elevation of Systemic Oxygen Delivery in Critically Ill Patients

“…Multiple organ dysfunction syndrome remains the lead cause of morbidity and mortality in intensive care patients [1]. The etiology of MODS is multifactorial and is likely precipitated by a combination of tissue hypoperfusion, hypoxia, metabolic derangement, and mitochondrial dysfunction [2].…”