Document Detail


Impact of intensive care unit organ failures on mortality during the five years after a critical illness.
MedLine Citation:
PMID:  22837381     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: The relationship between organ failure during critical illness and long-term survival is uncertain, especially among intensive care unit (ICU) survivors.
OBJECTIVES: To describe the relationship between individual organ failures, total organ failure burden, and mortality during the 5 years after an episode of critical illness.
METHODS: We studied a cohort of sequential admissions to 10 Scottish ICUs (n = 872). Logistic regression was used to explore independent associations between organ failures and mortality over a 5-year time horizon, adjusting for potential confounders.
MEASUREMENTS AND MAIN RESULTS: Daily Sequential Organ Failure Assessment scores described organ dysfunction during ICU stay. The sum of the worst scores at any time point during the ICU stay for each organ system except neurological dysfunction was used to calculate total organ failure burden. Mortality was obtained from the national death register. Five-year mortality was 58.2%; 34.4% of deaths occurred within 28 days. In adjusted analyses, cardiovascular (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.8-3.7), liver (OR, 2.3; 95% CI, 1.1-5.0), and respiratory failure (OR, 2.1; 95% CI, 1.3-3.5) were independently associated with 5-year mortality. Organ failure burden was strongly associated with mortality; 81% of patients in the highest tertile died during follow-up (OR, 6.3 relative to lowest tertile; P < 0.001). Patients surviving more than 12 months post-ICU were still more likely to subsequently die if they experienced greater organ failure burden in the ICU (OR, 2.4; P = 0.02, highest vs. lowest tertile).
CONCLUSIONS: Cardiovascular, respiratory, and liver failures during critical illness strongly predict subsequent 5-year survival. Acute organ failure burden is associated with long-term mortality even among patients who survive up to 1 year after ICU admission.
Authors:
Nazir I Lone; Timothy S Walsh
Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-07-26
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  186     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  2013-01-04     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  640-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cohort Studies
Critical Illness / mortality*,  therapy
Female
Health Status Indicators
Hospitalization
Humans
Intensive Care*
Male
Middle Aged
Multiple Organ Failure / etiology,  mortality*,  therapy
Risk Factors
Scotland
Survival Rate
Time Factors
Grant Support
ID/Acronym/Agency:
CAF/08/12//Chief Scientist Office; G0901697//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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