Patterns and early evolution of organ failure in the intensive care unit and their relation to outcomeReport as inadecuate




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Critical Care

, 16:R222

First Online: 16 November 2012Received: 22 May 2012Revised: 29 July 2012Accepted: 20 August 2012

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.

AbbreviationsCNScentral nervous system

GCSGlasgow Coma Scale

ICUintensive care unit

MOFmultiple organ failure

SAPSsimplified acute physiology score

SIRSsystemic inflammatory response syndrome

SOFAsequential organ failure assessment.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11868 contains supplementary material, which is available to authorized users.

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Author: Yasser Sakr - Suzana M Lobo - Rui P Moreno - Herwig Gerlach - V Marco Ranieri - Argyris Michalopoulos - Jean-Louis Vince

Source: https://link.springer.com/



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