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Individual Organ Failure and Concomitant Risk of Mortality Differs According to the Type of Admission to ICU - A Retrospective Study of SOFA Score of 23,795 Patients.

Bingold TM, Lefering R, Zacharowski K, Meybohm P, Waydhas C, Rosenberger P, Scheller B, DIVI Intensive Care Registry Gro - PLoS ONE (2015)

Bottom Line: M 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).The dynamic evolution of OD/OF within 72h after ICU admission and mortality differed between patients depending on their types of admission.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.

ABSTRACT

Introduction: 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. 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.

Methods: 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). 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.

Results: M 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).

Conclusion: The 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.

No MeSH data available.


Related in: MedlinePlus

Prevalence of Organ dysfunction and failure per organ at admission to ICU and at day 3.Depicted are the prevalences (mean group ± 95% CI) of organ dysfunction (SOFA score 1–2 points) and organ failure (SOFA score 3–4 points) on admission and on day 3 of ICU in respect to the type of admission in patients with an ICU LOS of at least five days. M-patients had on admission to ICU and on day 3 less heart failure (B) and less coagulation dysfunction (D), but a higher proportion of respiratory (A) and renal failure (C) than the ScS and the US patients. ScS, scheduled surgery; US, unscheduled surgery; M, medical; Adm, admission to ICU; day 3 day 3 of ICU treatment; normal, individual organ SOFA score 0 points; dysfunction, individual organ SOFA score 1–2 points; failure, individual organ SOFA score 3–4 points.
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pone.0134329.g004: Prevalence of Organ dysfunction and failure per organ at admission to ICU and at day 3.Depicted are the prevalences (mean group ± 95% CI) of organ dysfunction (SOFA score 1–2 points) and organ failure (SOFA score 3–4 points) on admission and on day 3 of ICU in respect to the type of admission in patients with an ICU LOS of at least five days. M-patients had on admission to ICU and on day 3 less heart failure (B) and less coagulation dysfunction (D), but a higher proportion of respiratory (A) and renal failure (C) than the ScS and the US patients. ScS, scheduled surgery; US, unscheduled surgery; M, medical; Adm, admission to ICU; day 3 day 3 of ICU treatment; normal, individual organ SOFA score 0 points; dysfunction, individual organ SOFA score 1–2 points; failure, individual organ SOFA score 3–4 points.

Mentions: The most common organ failure was cardiovascular both on ICU admission (35.7%) and after 72h (34.4%). However, this particular organ failure was lowest in the M patients in comparison to ScS and US patients (Fig 4).


Individual Organ Failure and Concomitant Risk of Mortality Differs According to the Type of Admission to ICU - A Retrospective Study of SOFA Score of 23,795 Patients.

Bingold TM, Lefering R, Zacharowski K, Meybohm P, Waydhas C, Rosenberger P, Scheller B, DIVI Intensive Care Registry Gro - PLoS ONE (2015)

Prevalence of Organ dysfunction and failure per organ at admission to ICU and at day 3.Depicted are the prevalences (mean group ± 95% CI) of organ dysfunction (SOFA score 1–2 points) and organ failure (SOFA score 3–4 points) on admission and on day 3 of ICU in respect to the type of admission in patients with an ICU LOS of at least five days. M-patients had on admission to ICU and on day 3 less heart failure (B) and less coagulation dysfunction (D), but a higher proportion of respiratory (A) and renal failure (C) than the ScS and the US patients. ScS, scheduled surgery; US, unscheduled surgery; M, medical; Adm, admission to ICU; day 3 day 3 of ICU treatment; normal, individual organ SOFA score 0 points; dysfunction, individual organ SOFA score 1–2 points; failure, individual organ SOFA score 3–4 points.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524700&req=5

pone.0134329.g004: Prevalence of Organ dysfunction and failure per organ at admission to ICU and at day 3.Depicted are the prevalences (mean group ± 95% CI) of organ dysfunction (SOFA score 1–2 points) and organ failure (SOFA score 3–4 points) on admission and on day 3 of ICU in respect to the type of admission in patients with an ICU LOS of at least five days. M-patients had on admission to ICU and on day 3 less heart failure (B) and less coagulation dysfunction (D), but a higher proportion of respiratory (A) and renal failure (C) than the ScS and the US patients. ScS, scheduled surgery; US, unscheduled surgery; M, medical; Adm, admission to ICU; day 3 day 3 of ICU treatment; normal, individual organ SOFA score 0 points; dysfunction, individual organ SOFA score 1–2 points; failure, individual organ SOFA score 3–4 points.
Mentions: The most common organ failure was cardiovascular both on ICU admission (35.7%) and after 72h (34.4%). However, this particular organ failure was lowest in the M patients in comparison to ScS and US patients (Fig 4).

Bottom Line: M 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).The dynamic evolution of OD/OF within 72h after ICU admission and mortality differed between patients depending on their types of admission.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.

ABSTRACT

Introduction: 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. 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.

Methods: 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). 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.

Results: M 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).

Conclusion: The 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.

No MeSH data available.


Related in: MedlinePlus