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

Yasser Sakr,Rui P Moreno,Herwig Gerlach,Jean-Louis Vincent,Argyris Michalopoulos,Suzana M Lobo,V Marco Ranieri

doi:10.1186/cc11868

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.

Highlights

Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients
Characteristics of the study group Of the 3,147 patients included in the sepsis occurrence in acutely ill patients (SOAP) database, 2,933 patients stayed in the intensive care unit (ICU) for more than 48 hours (Table 1)
Patterns of organ failure and their relation to outcome On admission to the ICU, 1,675 (57.1%) patients had at least one organ failure; these patients had ICU and hospital mortality rates of 27.6% and 34.2%, respectively

Summary

Introduction

Recognition 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. The Sequential Organ Failure Assessment (SOFA) score [6,7,8] was developed as a tool to describe quantitatively the time course of organ dysfunction [9,10]. The aim of our study was to investigate the relation between the patterns of early changes in organ function in the ICU and outcome from critical illness. The study set up the hypothesis that recognition of early changes in organ function may characterize the clinical course of critically ill patients. We explored the relative roles of sepsis and MOF in determining outcome in critically ill patients

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