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Published on: January 16, 2019
Decreasing magnitude of multiple organ dysfunction syndrome despite increasingly severe critical surgical illness: a
Philip S Barie1, Lynn J Hydo, Jian Shou
1Department of Surgery, Division of Critical Care and Trauma, Anne and Max A. Cohen Surgical Intensive Care Unit, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10065, USA. pbarie@med.cornell.edu
Background:
Multiple organ dysfunction syndrome (MODS) remains prevalent and the leading cause of mortality in the surgical intensive care unit (ICU). Improvements in ICU care in the last 10 years (e.g., tight glycemic control, activated protein C, fewer transfusions causing fewer nosocomial infections) may have decreased the incidence, magnitude, and mortality of MODS, as hypothesized in this study.
Methods:
Longitudinal 17-year prospective study of 11,314 ICU patients (academic/tertiary unit, Level I trauma center), 5,157 (45.5%) of whom developed any degree of MODS (Marshall score, cumulative). Data collected included Admission Acute Physiology and Chronic Health Evaluation (APACHE)-II and APACHE-III scores, MOD score (MODsc), hospital mortality, and the incidence and magnitude of MODS. The ratio of MODsc: APACHE III was calculated. Analyses (X +/- SEM, chi2, repeated-measures ANOVA, linear and polynomial regression, c-statistic) were performed for calendar-year intervals beginning in 1990 through 2006.
Results:
Among MODS patients, the mean MODsc was 6.3 +/- 0.1 points, and the mortality rate was 22%. The APACHE III score increased significantly (p < 0.0001) over time, but the mortality rate was unchanged (r2 = 0.02). Adjusted for illness severity (MODsc:A3), the magnitude of MODS decreased significantly (p < 0.0001) during the time period.
Conclusions:
Despite significant increases in admission APACHE III score over 17 years, the adjusted magnitude of MODS (MODsc:A3) decreased. Given the strong association between MODS and mortality for critically ill surgical patients, it is likely that the unchanged risk-adjusted mortality observed over time is due to the reduced magnitude of MODS.
Insights
Improvements in surgical intensive care unit (ICU) care have decreased the magnitude of multiple organ dysfunction syndrome (MODS). This reduction in MODS magnitude is likely responsible for unchanged risk-adjusted mortality rates in critically ill patients.
Area of Science:
- Critical Care Medicine
- Surgical Outcomes
- Public Health
Background:
- Multiple organ dysfunction syndrome (MODS) is a significant cause of mortality in surgical intensive care units (ICUs).
- Recent advancements in ICU care may have impacted MODS incidence, severity, and mortality.
- This study investigated the trends in MODS over a 17-year period.
Purpose of the Study:
- To evaluate the changes in the incidence, magnitude, and mortality of MODS over 17 years.
- To determine if improvements in ICU care have led to a decrease in MODS.
- To assess the relationship between MODS magnitude and risk-adjusted mortality.
Main Methods:
- A longitudinal 17-year prospective study of 11,314 ICU patients.
- Data included APACHE-II, APACHE-III scores, MOD score (MODsc), and hospital mortality.
- Statistical analyses were performed to assess trends and correlations over time.
Main Results:
- The mean MOD score among MODS patients was 6.3 +/- 0.1, with a 22% mortality rate.
- APACHE III scores significantly increased over time, but overall mortality remained unchanged.
- The adjusted magnitude of MODS (MODsc:A3) significantly decreased over the study period.
Conclusions:
- Despite increased illness severity at admission (APACHE III), the adjusted magnitude of MODS decreased.
- The reduction in MODS magnitude is likely responsible for the stable risk-adjusted mortality.
- These findings suggest that evolving ICU care has positively impacted MODS outcomes.