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Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome

Yasser Sakr1, Suzana M Lobo2, Rui P Moreno3, Herwig Gerlach4, V Marco Ranieri5, Argyris Michalopoulos6, Jean-Louis Vincent7* and the SOAP Investigators

Author Affiliations

1 Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena, Germany

2 Division of Critical Care Medicine, Department of Internal Medicine, Medical School-FUNFARME and Hospital de Base, São José do Rio Preto, São Paulo, Brazil

3 Dunidade de Cuidados Intensivos Neurocriticos, Hospital de São José, Centro Hospitalar de Lisboa Central, E.P.E., Rua José António Serrano, 1150-199 Lisbon, Portugal

4 Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukölln, Rudower Strasse 48, D-12313 Berlin, Germany

5 Department of Anesthesia and Critical Care, Ospedale S. Giovanni Battista-Molinette, corso Dogliotti 14, 10126, University of Turin, Turin, Italy

6 Intensive Care Unit, Henry Dunant Hospital, Department of Medicine, Athens, Greece

7 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Brussels, Belgium

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Critical Care 2012, 16:R222  doi:10.1186/cc11868

Published: 16 November 2012

Abstract

Introduction

Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome.

Methods

Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score.

Results

A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, P < 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors.

Conclusions

Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis.