Related Experiment Videos
A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome
P C Hebert1, A J Drummond, J Singer
1Division of Critical Care Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
Abstract:
A simple multiple system organ failure (MSOF) score may predict mortality of patients who have sepsis syndrome. Using an MSOF scoring system, we prospectively determined the presence or absence of respiratory, cardiovascular, renal, hepatic, gastrointestinal, hematologic, and neurologic organ failure on day 1 of sepsis syndrome in 154 consecutive patients who had sepsis syndrome in the ICU of a tertiary care, teaching hospital. We used 30-day hospital mortality as the primary outcome variable. Overall 30-day mortality was 34 percent. There was a strong linear association between number of organ system failures and 30-day mortality (p < 0.0001). Mortality was 20 percent in patients who had less than 3 organ system failures (n = 111) and 70 percent in patients who had 3 or more organ system failures (n = 43). Survival was assessed using the Cox proportional hazards model and was found to be significantly different (p < 0.01) between the two groups defined by the aforementioned dichotomy after adjustment for age and sex using time to death as the primary outcome. The increase in relative risk of death associated with 3 or more organ system failures was 2.77 (95 percent confidence interval, 2.74 to 2.83). Using logistic regression, the adjusted odds ratios (OR) for covariates most predictive of mortality were hematologic (OR = 6.2), neurologic (OR = 4.4), hepatic (OR = 3.4), cardiovascular (OR = 2.6), and age (1.05 per year). The logistic model using the seven organ system failures and age as covariates accurately predicted outcome 75 percent of the time with a sensitivity of 51 percent and specificity of 87 percent. In conclusion, a simple scoring system tabulating the number of organ system failures present on day 1 of sepsis syndrome predicts the mortality of patients who have sepsis syndrome with reasonable accuracy.
Insights
A simple Multiple System Organ Failure (MSOF) score can predict sepsis mortality. Patients with three or more organ failures face significantly higher death risks, aiding in early risk stratification for sepsis syndrome.
Area of Science:
- Critical Care Medicine
- Clinical Epidemiology
Background:
- Sepsis syndrome is a life-threatening condition characterized by dysregulated host response to infection.
- Predicting mortality in sepsis patients is crucial for timely and effective clinical management.
Purpose of the Study:
- To evaluate the predictive accuracy of a simple Multiple System Organ Failure (MSOF) scoring system for 30-day mortality in sepsis syndrome patients.
- To identify key organ systems contributing to mortality risk in sepsis.
Main Methods:
- Prospective study of 154 consecutive sepsis syndrome patients in an ICU.
- Assessment of seven organ systems (respiratory, cardiovascular, renal, hepatic, gastrointestinal, hematologic, neurologic) for failure on day 1.
- Utilized 30-day hospital mortality as the primary outcome, analyzed with Cox proportional hazards model and logistic regression.
Main Results:
- Overall 30-day mortality was 34%.
- A strong linear association was found between the number of organ system failures and mortality (p < 0.0001).
- Mortality was 20% for <3 organ failures vs. 70% for ≥3 organ failures. Hematologic and neurologic failures were most predictive of mortality.
Conclusions:
- The number of organ system failures on day 1 of sepsis syndrome is a simple yet effective predictor of 30-day mortality.
- The MSOF score provides reasonable accuracy in predicting outcomes for sepsis patients.
- This scoring system can aid clinicians in risk stratification and resource allocation for sepsis management.