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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

Multivariate, forward stepwise logistic regression analysis with intensive care unit mortality as the dependent factor and OD/OF at day 3.All data are adjusted to age, gender and organ dysfunction/organ failure at admission. Odds ratio is depicted in a logarithmic plotting (n = 23,795). In organ dysfunction only a significantly increased risk of death is observed in the M-patients with lung dysfunction. The highest risk of death is found in M-patients with cardiovascular or liver failure, as well as in ScS patients with liver or renal failure. In US-patients renal failure was accompanied with the highest risk of death. OR, odds ratio; CI, confidence interval; OD, organ dysfunction; OF, organ failure; CV, cardiovascular; ScS, scheduled surgery; US, unscheduled surgery; M, medical.
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pone.0134329.g005: Multivariate, forward stepwise logistic regression analysis with intensive care unit mortality as the dependent factor and OD/OF at day 3.All data are adjusted to age, gender and organ dysfunction/organ failure at admission. Odds ratio is depicted in a logarithmic plotting (n = 23,795). In organ dysfunction only a significantly increased risk of death is observed in the M-patients with lung dysfunction. The highest risk of death is found in M-patients with cardiovascular or liver failure, as well as in ScS patients with liver or renal failure. In US-patients renal failure was accompanied with the highest risk of death. OR, odds ratio; CI, confidence interval; OD, organ dysfunction; OF, organ failure; CV, cardiovascular; ScS, scheduled surgery; US, unscheduled surgery; M, medical.

Mentions: In the multivariate logistic regression analysis of patients with an ICU length of stay of at least 5 days, with mortality as the dependent variable, the type of admission was associated with different estimates of the risk of death in all individual organ systems except for coagulation failure (Fig 5). In the US patients respiratory failure on day three had a markedly lower odds ratio (1.38) than M (2.41) or ScS (2.37) patients. By contrast, renal failure was accompanied with a markedly higher odds ratio in surgical than medical patients (OR for ScS 2.69, US 2.35, M 1.72). For medical patients heart failure had the highest impact on mortality (OR 2.93).


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)

Multivariate, forward stepwise logistic regression analysis with intensive care unit mortality as the dependent factor and OD/OF at day 3.All data are adjusted to age, gender and organ dysfunction/organ failure at admission. Odds ratio is depicted in a logarithmic plotting (n = 23,795). In organ dysfunction only a significantly increased risk of death is observed in the M-patients with lung dysfunction. The highest risk of death is found in M-patients with cardiovascular or liver failure, as well as in ScS patients with liver or renal failure. In US-patients renal failure was accompanied with the highest risk of death. OR, odds ratio; CI, confidence interval; OD, organ dysfunction; OF, organ failure; CV, cardiovascular; ScS, scheduled surgery; US, unscheduled surgery; M, medical.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0134329.g005: Multivariate, forward stepwise logistic regression analysis with intensive care unit mortality as the dependent factor and OD/OF at day 3.All data are adjusted to age, gender and organ dysfunction/organ failure at admission. Odds ratio is depicted in a logarithmic plotting (n = 23,795). In organ dysfunction only a significantly increased risk of death is observed in the M-patients with lung dysfunction. The highest risk of death is found in M-patients with cardiovascular or liver failure, as well as in ScS patients with liver or renal failure. In US-patients renal failure was accompanied with the highest risk of death. OR, odds ratio; CI, confidence interval; OD, organ dysfunction; OF, organ failure; CV, cardiovascular; ScS, scheduled surgery; US, unscheduled surgery; M, medical.
Mentions: In the multivariate logistic regression analysis of patients with an ICU length of stay of at least 5 days, with mortality as the dependent variable, the type of admission was associated with different estimates of the risk of death in all individual organ systems except for coagulation failure (Fig 5). In the US patients respiratory failure on day three had a markedly lower odds ratio (1.38) than M (2.41) or ScS (2.37) patients. By contrast, renal failure was accompanied with a markedly higher odds ratio in surgical than medical patients (OR for ScS 2.69, US 2.35, M 1.72). For medical patients heart failure had the highest impact on mortality (OR 2.93).

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