Multiple organ dysfunction: Baseline and serial component scores
Multiple organ dysfunction: Baseline and serial component scores
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DOI：
10.1097/00003246-200111000-00002
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发表时间：
2001-11-01
影响因子：
8.8
通讯作者：
Marshall, J
中科院分区：
文献类型：
--
作者：
Cook, R;Cook, D;Marshall, J
目的：多器官功能障碍评分(MODS)描述和量化器官特有的生理功能。本研究的目的是检测重症监护室(ICU)入院时和ICU期间MODS的六个组成部分(心血管、呼吸、肾脏、中枢神经系统、肝脏和血液学)与ICU死亡时间的关系。设计：前瞻性观察性队列研究。16名加拿大ICU患者，共计1,200名患者接受了48小时的机械通气。测量和主要结果。组成MODS的六个器官系统在ICU入院时(基线评分)和此后的每天进行测量。每天器官功能障碍的变化(系列分数)计算为每日分量分数减去相应的基线分量分数。在COX回归分析中，独立解释变量为基线和连续测量的MODS分量，因变量为入院至ICU死亡时间。当单独分析每个器官系统时，心血管、呼吸、肾脏、中枢神经系统和血液学成分的基线和系列MODS都与ICU死亡率显著相关。在调整了连续的肝脏评分后，基线的肝脏评分与死亡率无关。在调整了所有基线和系列MODS成分后，有四个器官系统与ICU死亡率显著相关：心血管(基线相对风险[RR]，1.5；系列RR，1.4)；呼吸系统(基线RR，1.4；系列RR，1.4)；肾脏(基线RR，1.3；系列RR，1.5)；以及中枢神经系统(基线RR，1.6；系列RR，1.7)。我们发现，与器官功能障碍相关的死亡相对风险随时间和器官系统的不同而显著不同。直到ICU第二周(第1周：RR，1.1[0.9-1.4]；第2周：RR，1.9[1.5-2.4])，基线呼吸功能与死亡率没有关联；通过连续呼吸评分测量的呼吸功能变化也是如此(第1周：RR，1.2[1.0-1.5]；第2周：RR，1.7[1.4-2.1])。直到ICU第4周(第1-3周：RR，0，9[0.7-1.1]；第4周以后：RR，1.4[1.0-2.0])，连续肝功能评分才与死亡率相关。结论：器官功能障碍评分描述了ICU入院时和住ICU期间的生理状况。尽管模式因系统不同而不同，每日MODS成分评分提供了比基线MODS更多的预后价值。
Objective: The multiple organ dysfunction score (MODS) describes and quantifies organ-specific physiology. The objective of this study was to examine the relation between six components of MODS (cardiovascular, respiratory, renal, central nervous system, hepatic, and hematologic) measured at admission to the intensive core unit (ICU) and during the ICU stay, with time to death in the ICU.Design: Prospective observational cohort study.Setting. Sixteen Canadian ICUs.Patients., A total of 1,200 patients were mechanically ventilated for > 48 hrs.Measurements and Main Results. The six organ systems comprising MODS were measured at ICU admission (baseline scores) and daily thereafter. The change in organ dysfunction each day (serial scores) were calculated as daily component scores minus the corresponding baseline component scores. In Cox regression analyses, the independent explanatory variables were the MODS components measured at baseline and serially, and the dependent variable was the time from admission to ICU mortality. When each organ system was analyzed individually, both the baseline and serial MODS for the cardiovascular, respiratory, renal, central nervous system, and hematologic components were significantly associated with ICU mortality. After adjusting for the serial hepatic score, the baseline hepatic score was unrelated to mortality. After adjusting for all baseline and serial MODS components in aggregate, four organ systems were significantly associated with ICU mortality: cardiovascular (baseline relative risk [RR], 1.5; serial RR, 1.4); respiratory (baseline RR, 1.4; serial RR, 1.4); renal (baseline RR, 1.3; serial RR, 1.5); and central nervous system (baseline RR, 1.6; serial RR, 1.7). We found that the relative risk of mortality related to organ dysfunction varied significantly over time and among organ systems. Baseline respiratory function was not associated with mortality until the second ICU week (week 1: RR, 1.1 [0.9-1.4]; week 2 onward: RR, 1.9 [1.5-2.4]); the same was true for the change in respiratory function as measured by the serial respiratory score (week 1: RR, 1.2 [1.0-1.5]; week 2 onward: RR, 1.7 [1.4-2.1]). The serial hepatic score was not associated with mortality until the fourth ICU week (weeks 1-3: RR, 0,9 [0.7-1.1]; week 4 onward: RR, 1.4 [1.0-2.0]).Conclusions: Organ dysfunction scores describe physiology at ICU admission and during ICU stay. Although patterns vary by system, daily MODS component scores provide additional prognostic value over baseline MODS.