[Significance of multiple organ failure for the prognosis of surgical intensive care patients].
BACKGROUND
The association of multiple organ failure and acute prognosis is an established fact in intensive care medicine. However, it is unclear whether the number of failing organs is an independent determinant of acute mortality, and whether there are additional effects on long-term outcome.


METHODS
We performed a retrospective, observational cohort study using prospectively collected data from March 1993, through February 2005. Three different cohorts were analysed: patients with a short-term intensive care unit (ICU) stay (group I, ICU length of stay > 4 days), with a long-term ICU stay (group II, ICU length of stay > 28 days), and all patients requiring renal replacement therapy during ICU stay (group III). Organ failure was defined according to a modified Goris score. An independent effect of the number of failing organs on patient prognosis was evaluated after adjusting for more than 15 covariables. Acute prognosis was analysed in group I, whereas long-term prognosis was studied in groups II and III.


RESULTS
The maximum number of failing organs was an independent determinant of acute prognosis in patients of group I, and of long-term prognosis in groups II and III.


CONCLUSIONS
The effect of multiple organ failure on long-term prognosis emphasizes the importance of this variable for patient outcome. Therefore, multiple organ failure must be part of all therapeutic concepts in critical care. Within those, preventive measures are definitively preferable to keep the number of failing organs as small as possible.
Hartl
W H
WH
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München. whartl@med.uni-muenchen.de
Wolf
H
H
Schneider
C P
CP
Fertmann
J
J
Küchenhoff
H
H
Jauch
K-W
KW
D018806:APACHE; D002395:Catecholamines / Q000097:blood; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
D002395:Catecholamines