Abstract
IntroductionOrgan dysfunction or failure after the first days of ICU treatment and subsequent mortality with respect to the type of intensive care unit (ICU) admission is poorly elucidated. Therefore we analyzed the association of ICU mortality and admission for medical (M), scheduled surgery (ScS) or unscheduled surgery (US) patients mirrored by the occurrence of organ dysfunction/failure (OD/OF) after the first 72h of ICU stay.MethodsFor this retrospective cohort study (23,795 patients; DIVI registry; German Interdisciplinary Association for Intensive Care Medicine (DIVI)) organ dysfunction or failure were derived from the Sequential Organ Failure Assessment (SOFA) score (excluding the Glasgow Coma Scale). SOFA scores were collected on admission to ICU and 72h later. For patients with a length of stay of at least five days, a multivariate analysis was performed for individual OD/OF on day three.ResultsM patients had the lowest prevalence of cardiovascular failure (M 31%; ScS 35%; US 38%), and the highest prevalence of respiratory (M 24%; ScS 13%; US 17%) and renal failure (M 10%; ScS 6%; US 7%). Risk of death was highest for M- and ScS-patients in those with respiratory failure (OR; M 2.4; ScS 2.4; US 1.4) and for surgical patients with renal failure (OR; M 1.7; ScS 2.7; US 2.4).ConclusionThe dynamic evolution of OD/OF within 72h after ICU admission and mortality differed between patients depending on their types of admission. This has to be considered to exclude a systematic bias during multi-center trials.
Highlights
Organ dysfunction or failure after the first days of ICU treatment and subsequent mortality with respect to the type of intensive care unit (ICU) admission is poorly elucidated
Scoring systems for the prediction of mortality in ICU patients often incorporate three main categories for “type of admission”, namely “scheduled surgery”, “unscheduled surgery” and “medical” [1,2,3]. Another important scoring system objectively describes the degree of organ dysfunction and/or failure, and their associated morbidity over time (Sequential Organ Failure Assessment (SOFA) Score) [4]
A retrospective analysis primarily designed to assess morbidity using the European/North American Study of Severity System database found a close correlation between the SOFA score at ICU admission (SOFAadm) and patient outcome [4]
Summary
For this retrospective cohort study (23,795 patients; DIVI registry; German Interdisciplinary Association for Intensive Care Medicine (DIVI)) organ dysfunction or failure were derived from the Sequential Organ Failure Assessment (SOFA) score (excluding the Glasgow Coma Scale). This study represents a retrospective analysis of a registry including 122,215 patients treated at 75 ICUs from 2000 to 2010, and prospectively documented in the German Interdisciplinary Association for Intensive Care Medicine (DIVI) registry (Fig 1). The interdisciplinary registry contains a core dataset for intensive care medicine in Germany [9]. It contains data regarding the type and structure of the participating ICUs (recorded annually), admission (recorded once per patient) and daily patient data
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