Severity stratification and outcome prediction for multisystem organ failure and dysfunction.
Severity stratification and outcome prediction for multisystem organ failure and dysfunction.
复制标题
多系统器官衰竭和功能障碍的严重程度分层和结果预测。
DOI：
10.1007/s002689900063
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发表时间：
1996
影响因子：
2.6
通讯作者：
Wagner,DP
中科院分区：
文献类型：
--
作者：
Zimmerman,JE;Knaus,WA;Sun,X;Wagner,DP
多器官功能衰竭或功能障碍（MOSF/MODS）仍然是住院成人发病率和死亡率的主要原因。在重症监护病房（ICU）患者中，生理紊乱的程度、相关疾病或损伤的类型、年龄的增加和危及生命的共病是20世纪80年代发生MOSF和生存的主要决定因素。单一器官系统衰竭（OSF）持续超过1天的患者的住院死亡率接近40%;对于那些有两个OSF的患者，住院死亡率增加到60%。这些结果在过去十年中没有改变。然而，对于OSF 3天后仍有3个或3个以上OSF的患者，数据表明，在1982年至1990年期间，死亡率已从98%降至84%（p <0.05）。 = 0.0003）。由于OSF的类型和组合、相关疾病和生理紊乱程度的变化，很难解释使用分类标准定义的一种或多种OSF患者的死亡率变化。由于这一点和其他原因，基于患者风险因素的综合评估的结局预测是一种比简单计数OSF的数量和持续时间更敏感、更具体、更有用的量化MODS的方法。由于在随后的ICU期间对风险因素的重复评估反映了并发症和对治疗的反应，因此每日结果预测甚至比ICU入院时的估计更精确。更准确地预测MODS/MOSF生存率的能力可以提高我们测试新疗法的能力，评估结果如何随时间变化，并评估支持疗法对个体的疗效。
Multiple organ system failure or dysfunction (MOSF/MODS) remains a major cause of morbidity and mortality in hospitalized adults. Among intensive care unit (ICU) patients the extent of physiologic derangement, the type of associated disease or injury, increasing age, and life-threatening comorbid conditions are the major determinants of risk for developing MOSF and for survival during the 1980s. Hospital mortality for patients with a single organ system failure (OSF) lasting more than 1 day approached 40%; and for those with two OSFs hospital mortality increased to 60%. These outcomes did not change over the decade. For patients with three or more OSFs persisting after 3 days of OSF, however, data suggest that between 1982 and 1990 the mortality has been reduced from 98% to 84% (p = 0.0003). Because of variations in the types and combinations of OSFs, associated disease, and extent of physiologic derangement, it is difficult to interpret variations in mortality among patients with one or more OSFs defined using categorical criteria. For this and other reasons, outcome prediction based on a comprehensive assessment of patient risk factors is a more sensitive, specific, useful approach to quantifying MODS than a simple count of the number and duration of OSFs. Because repeated assessment of risk factors during subsequent ICU days reflects complications and response to therapy, daily outcome predictions are even more precise than estimates at ICU admission. The ability to more accurately predict survival from MODS/MOSF can improve our ability to test new therapies, evaluate how outcome has changed over time, and assess the efficacy of supportive therapy for individuals.