Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome.
Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome.
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DOI：
10.1186/cc11868
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发表时间：
2012-11-16
期刊：
影响因子：
--
通讯作者：
SOAP Investigators
中科院分区：
文献类型：
--
作者：
Sakr Y;Lobo SM;Moreno RP;Gerlach H;Ranieri VM;Michalopoulos A;Vincent JL;SOAP Investigators
器官衰竭模式的识别可能有助于描述危重患者的临床过程。我们调查了重症监护病房（ICU）患者器官功能障碍/衰竭的早期变化模式及其与预后的关系。我们使用来自一项大型前瞻性欧洲研究的数据库，研究了2,933名在ICU停留超过48小时的患者，并描述了器官衰竭的模式及其与结局的关系。患者被分为三组：无脓毒症的患者，在ICU入院后的前48小时内被诊断为脓毒症的患者，以及在入院后48小时以上发生脓毒症的患者。采用序贯器官衰竭评估（SOFA）评分评估器官功能障碍。共有2，110名患者（占研究人群的72%）在ICU住院期间的某个时间点发生器官衰竭。与SOFA评分不变或增加的患者相比，在进入ICU后24小时内器官功能改善的患者的ICU和住院死亡率较低（12.4和18.4%对19.6和24.5%，P < 0.05，成对）。正如预期的那样，器官衰竭在脓毒症患者中比在非脓毒症患者中更常见。在单器官衰竭患者中，脓毒症患者的住院死亡率高于非脓毒症患者。然而，在多器官衰竭患者中，无论是否存在脓毒症，死亡率均相似。无论是否存在脓毒症，在ICU的前4天内，死亡者的δ SOFA评分高于存活者，存活者的δ SOFA评分随时间显著下降。器官功能的早期变化与结果密切相关。在单器官衰竭患者中，脓毒症患者的住院死亡率高于非脓毒症患者。然而，在多器官衰竭中，死亡率不受脓毒症的影响。
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. 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. 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. 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.
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影响因子：
8.8
作者：
Vincent, JL;Sakr, Y;Payen, D
通讯作者：
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38.9
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