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Factors related to multiple organ system failure and mortality in a surgical intensive care unit
D D Tran1, E B Van Onselen, A J Wensink
1Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.
Abstract:
We retrospectively studied the relative contribution of factors related to the extent of multiple organ system failure (MOSF) and mortality, using multivariate methods to account for the interactions between studied factors, in 538 consecutive patients admitted to a surgical intensive care unit during a 1-year period. MOSF (MOSF score > or = 5) occurred in 88 (16%) of patients. Multiple linear regression selected advancing age, malnutrition, APACHE II score, shock and coma on admission, number of blood transfusions, use of H2 receptor antagonists or antacids, bacteraemia and intra-abdominal infection as independent factors related to the MOSF score. MOSF mortality was 52% and was a major cause of death in critically ill surgical patients. Multiple logistic regression selected advancing age, malnutrition, bacteraemia, APACHE II and MOSF score as major predictors of mortality. Advancing age, malnutrition, shock and coma on admission, transfusion requirement and use of H2 receptor antagonists or antacids may impair host defences of the gastrointestinal tract and enhance the vulnerability for invasive infection, thereby aggravating the severity of existing MOSF. Together with the predominance of Enterobacteriaceae in infected patients, these results suggest that translocation of intestinal bacteria and endotoxin may be important in the evolution and perpetuating the MOSF syndrome. Our results may be useful in devising strategies to prevent or limit the evolution of MOSF and to improve survival in patients with critical illness.
Insights
Multiple organ system failure (MOSF) is common in surgical ICU patients. Factors like age, malnutrition, and infections predict MOSF and mortality, suggesting strategies to improve survival.
Area of Science:
- Critical Care Medicine
- Surgical Intensive Care
- Infectious Disease Epidemiology
Background:
- Multiple organ system failure (MOSF) is a significant cause of mortality in critically ill surgical patients.
- Understanding factors contributing to MOSF is crucial for improving patient outcomes.
Purpose of the Study:
- To identify factors associated with the extent of MOSF and mortality in surgical intensive care unit (SICU) patients.
- To explore the interactions between these factors using multivariate analysis.
Main Methods:
- Retrospective study of 538 consecutive SICU patients over a 1-year period.
- Multivariate regression analyses (linear and logistic) to determine independent predictors.
- Calculation of MOSF score to quantify organ system failure.
Main Results:
- MOSF (score ≥ 5) occurred in 16% of patients, with a 52% mortality rate.
- Independent factors related to MOSF score included: age, malnutrition, APACHE II score, shock, coma, blood transfusions, H2 receptor antagonists/antacids, bacteraemia, and intra-abdominal infection.
- Major predictors of mortality were: age, malnutrition, bacteraemia, APACHE II score, and MOSF score.
Conclusions:
- Advancing age, malnutrition, shock, coma, transfusion needs, and certain medications may compromise gastrointestinal defenses, increasing infection risk and MOSF severity.
- Bacterial translocation from the gut may play a role in MOSF evolution and perpetuation.
- Findings can inform strategies to prevent MOSF and enhance survival in critically ill surgical patients.