title: Study of clinical course of organ dysfunction in intensive care.
abstract: OBJECTIVE
  Multiple organ dysfunction is a common cause of death in intensive care units. We describe the daily course of multiple organ dysfunction measured by the Sequential Organ Failure Assessment score in a population-based cohort of critically ill patients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Adult multisystem intensive care units in the Calgary Health Region.
  
  
  METHODS
  A total of 1,436 patients admitted from May 1, 2000 to April 30, 2001.
  
  
  METHODS
  Temporal change in Sequential Organ Failure Assessment score.
  
  
  METHODS
  None; observational study.
  
  
  RESULTS
  The mean age was 58 yrs (range, 14-100). The mean +/- sd intensive care unit admission Acute Physiology and Chronic Health Evaluation II score was 25 +/- 9. The median intensive care unit length of stay was 4 days (interquartile range, 2-8), and the median hospital length of stay was 15 days (interquartile range, 7-32). A total of 20.5% of patients were infected at admission, and 26.0% were immediately postoperative. Intensive care unit mortality was 27.0%, and hospital mortality was 35.1%. The daily Sequential Organ Failure Assessment score was significantly higher in nonsurvivors than survivors. A population-averaged model determined a mean rate of change of Sequential Organ Failure Assessment score to be -0.29 per day (95% confidence interval, -0.32 to -0.25) for survivors and -0.03 per day (95% confidence interval, -0.08 to 0.03) for nonsurvivors (overall regression, p <.0001). Patients with infection had higher admission Sequential Organ Failure Assessment scores compared with patients without infection (difference, 1.8; p <.001), but a similar rate of daily change.
  
  
  CONCLUSIONS
  Multiple organ dysfunction, does not follow a course of progressive and sequential failure. Evidence of differential daily change should further inform the use of organ failure scores as surrogate outcomes in clinical trials.
authors.affiliation: Department of Critical Care Medicine, Unversity of Calgary, Alberta, Canada.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Doig
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Fick
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Laupland
authors.forename: Paul J E
authors.initials: PJ
authors.lastname: Boiteau
authors.forename: Reza
authors.initials: R
authors.lastname: Shahpori
authors.forename: Tom
authors.initials: T
authors.lastname: Rosenal
authors.forename: J Dean
authors.initials: JD
authors.lastname: Sandham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000401:mortality; D011446:Prospective Studies; D013997:Time Factors