Hospital outcome of ICU patients in multi-organ failure

Abstract

Objective: To assess hospital outcome of intensive care unit (ICU) patients in multi-organ failure. Design: Prospective study. Setting: Multi-disciplinary ICU in a tertiary level post-graduate centre. Subjects: All patients (n=907) admitted to the ICU between April 1989 and September 1992. Interventions: None. Measurements and main results: The number and duration of organ system failures (OSFs) were related to outcome at hospital discharge. The hospital mortality of patients in acute OSF was as follows: one OSF 21%, two OSFs 44% and three or more OSFs 69%. The duration of OSF from one to seven days did not significantly alter the percentage mortality. In patients with three or more OSFs for three or more days, neurological failure (GCS ≤⃒ 6) adversely affected hospital outcome unlike the combined presence of cardiovascular, respiratory and renal failure which had no effect on outcome. Mortality rates for patients in acute OSF were lower than previously reported and 13 patients (33%) with three or more OSFs for three or more days were discharged alive from hospital. Conclusion: Neurological failure significantly increases the mortality of ICU patients. Though the number of OSF correlated with mortality, it is not a good prognostic indicator of hospital outcome of ICU patients. These results do not indicate which patients in multi-organ failure syndrome (MOFS) should be actively supported and for how long. Further comparable studies can help delineate which patients could benefit from continuing therapy.