title: Impact of preoperative organ failures on survival in intensive care unit patients with colectomy.
abstract: BACKGROUND
  The present study aimed to evaluate the prognostic value of preoperative changes in sequential organ failure assessment (SOFA) score, daily norepinephrine (NE) dose, lactate, C-reactive protein, and white blood cell count among patients with colectomy in the intensive care unit (ICU).
  
  
  METHODS
  We performed a retrospective analysis of 77 colectomized patients (30 female, 47 male) who were treated in a single tertiary-level mixed ICU during 2000-2009.
  
  
  RESULTS
  The underlying conditions leading to colectomy included sepsis (31 patients), cardiovascular operations (21 patients), and fulminant Clostridium difficile colitis (25 patients). The 28-day mortality was 53.3 % (41/77). Nonsurvivors had significantly higher median values than survivors (p < 0.05) for the following parameters: admission SOFA [10.0 (25th-75th percentile 8.0-13.0) vs. 9.0 (6.5-10.0)], highest SOFA [14.0 (12.0-16.0) vs. 12.5 (9.5-14.5)], operative day lactate level (6.3 vs. 2.2 mmol/L), and NE dose (16.8 vs. 9.3 total mg/day). During the last three preoperative days, significant increases were observed in total SOFA score (p < 0.001) and in cardiovascular (p < 0.001), coagulation (p = 0.017), renal (p < 0.01), and respiratory (p < 0.001) SOFA subscores, without statistically significant differences between nonsurvivors and survivors. Increasing Glasgow Coma Scale score, preoperative lactate level, and NE dose were significantly associated with mortality.
  
  
  CONCLUSIONS
  It should be prospectively studied whether preoperatively increasing lactate level and NE dose are surrogate markers for early laparotomy among ICU patents with colitis.
authors.affiliation: Division of Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland. seija.sipola@ppshp.fi
authors.forename: Seija
authors.initials: S
authors.lastname: Sipola
authors.forename: Hannu
authors.initials: H
authors.lastname: Syrjälä
authors.forename: Vesa
authors.initials: V
authors.lastname: Koivukangas
authors.forename: Jouko J
authors.initials: JJ
authors.lastname: Laurila
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.forename: Juha
authors.initials: J
authors.lastname: Saarnio
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003082:Colectomy / Q000401:mortality*; D003092:Colitis / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004334:Drug Administration Schedule; D004630:Emergencies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D007958:Leukocyte Count; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D063305:Organ Dysfunction Scores; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000316:Adrenergic alpha-Agonists; D015415:Biomarkers; D019344:Lactic Acid; D002097:C-Reactive Protein; D009638:Norepinephrine