Nonpulmonary organ dysfunction and its impact on outcome in patients with acute respiratory failure.
OBJECTIVE
This study aimed to define the prevalence, severity, and progression of nonpulmonary organ dysfunction, and its impact on outcome in patients with acute respiratory failure (ARF) at a respiratory ICU of a tertiary referral hospital in northern India.


METHODS
Daily patient data were collected on 711 adult patients with ARF to calculate component and total nonpulmonary sequential organ failure assessment (SOFA) scores. Hospital survival was the main outcome measure. Multiple logistic regression modeling was conducted to assess contribution of incremental dysfunction of various nonpulmonary organ systems to mortality. Kaplan-Meier curves were drawn to assess temporal trends in survival, and group comparisons were based on log-rank test. Cox proportional hazard modeling was performed to define hazards of earlier mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.


RESULTS
Four hundred seventy-five patients (66.8%) had one or more nonpulmonary organ dysfunctions at hospital admission. The overall hospital mortality rate was 33.9%. Hospital survival rates and median survival declined steadily as the number of organs involved increased. Admission, maximum, and DeltaSOFA scores were significantly higher in nonsurvivors. Increasing baseline cardiovascular and neurologic SOFA scores, and corresponding DeltaSOFA scores, were associated with progressively higher odds of hospital mortality, as well as increasing hazard for earlier mortality after adjustment for etiology of respiratory failure. Maximum nonpulmonary SOFA score was the best discriminator in predicting mortality (area under ROC curve, 0.767).


CONCLUSIONS
Baseline and new-onset nonpulmonary organ dysfunction significantly influences hospital survival in patients with ARF.
Aggarwal
Ashutosh N
AN
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 India.
Agarwal
Ritesh
R
Gupta
Dheeraj
D
Jindal
Surinder K
SK
D000208:Acute Disease; D000328:Adult; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007194:India; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D012720:Severity of Illness Index