• Critical care medicine · Feb 2004

    Study of clinical course of organ dysfunction in intensive care.

    • Christopher J Doig, David A Zygun, Gordon H Fick, Kevin B Laupland, Paul J E Boiteau, Reza Shahpori, Tom Rosenal, and J Dean Sandham.
    • Department of Critical Care Medicine, Unversity of Calgary, Alberta, Canada.
    • Crit. Care Med. 2004 Feb 1;32(2):384-90.

    ObjectiveMultiple organ dysfunction is a common cause of death in intensive care units. We describe the daily course of multiple organ dysfunction measured by the Sequential Organ Failure Assessment score in a population-based cohort of critically ill patients.DesignProspective cohort study.SettingAdult multisystem intensive care units in the Calgary Health Region.PatientsA total of 1,436 patients admitted from May 1, 2000 to April 30, 2001.MeasurementsTemporal change in Sequential Organ Failure Assessment score.InterventionsNone; observational study.Main ResultsThe mean age was 58 yrs (range, 14-100). The mean +/- sd intensive care unit admission Acute Physiology and Chronic Health Evaluation II score was 25 +/- 9. The median intensive care unit length of stay was 4 days (interquartile range, 2-8), and the median hospital length of stay was 15 days (interquartile range, 7-32). A total of 20.5% of patients were infected at admission, and 26.0% were immediately postoperative. Intensive care unit mortality was 27.0%, and hospital mortality was 35.1%. The daily Sequential Organ Failure Assessment score was significantly higher in nonsurvivors than survivors. A population-averaged model determined a mean rate of change of Sequential Organ Failure Assessment score to be -0.29 per day (95% confidence interval, -0.32 to -0.25) for survivors and -0.03 per day (95% confidence interval, -0.08 to 0.03) for nonsurvivors (overall regression, p <.0001). Patients with infection had higher admission Sequential Organ Failure Assessment scores compared with patients without infection (difference, 1.8; p <.001), but a similar rate of daily change.ConclusionsMultiple organ dysfunction, does not follow a course of progressive and sequential failure. Evidence of differential daily change should further inform the use of organ failure scores as surrogate outcomes in clinical trials.

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