Prediction of multiple organ dysfunction syndrome complicating acute myocardial infarction on the basis of comorbidities on admission.
BACKGROUND
Acute myocardial infarction (AMI) can be complicated by multiple organ dysfunction syndrome (MODS), but the exact influence of MODS on AMI remains unclear.


METHODS
This was a retrospective study of 6674 Chinese patients with AMI. The impact of MODS was assessed using the Cox proportional hazard model. Using the occurrence of MODS as the outcome, a prediction model was developed using the factors identified by logistic regression analysis and analyzed using receiving operator characteristic curves.


RESULTS
Of 6674 patients with AMI, 83 (1.2%) progressed to MODS. MODS independently predicted the risk of 30-day in-hospital mortality [hazard ratio, 2.3; 95% confidence interval (95% CI), 1.7-3.2; P<0.001]. Advanced age [odds ratio (OR), 2.76; 95% CI, 1.26-6.03; P=0.011 for age 65-74 years; OR, 4.85; 95% CI, 2.96-7.93; P<0.001 for age ≥75 years), pneumonia (OR, 4.27; 95% CI, 2.68-6.81; P<0.001), and chronic renal failure (OR, 2.09; 95% CI, 1.09-4.01; P=0.027) were associated independently with MODS. The area under the receiving operator characteristic curve for the predictive model was 0.802, indicating a good predictive value.


CONCLUSIONS
MODS can predict the worst severity of AMI. Using common clinical variables, it is possible to identify patients with AMI who are at high risk of MODS. Additional studies are necessary to confirm this model.
Departments of aGeriatrics bEmergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu cDepartment of Cardiology, General Hospital of PLA, Beijing, China.
Yu
Y
Liu
Xudong
X
Gu
Fang
F
Huang
Fang
F
Fang
Yusheng
Y
Zhao
Xiaoming
X
Qian
Wenhui
W
Wan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult