title: Risk Factors for Multiple Organ Dysfunction Syndrome in Severe Stroke Patients.
abstract: BACKGROUND
  Severe stroke patients have poor clinical outcome which may be associated with development of multiple organ dysfunction syndrome (MODS). Therefore, the aim of our study was to investigate independent risk factors for development of MODS in severe stroke patients.
  
  
  METHODS
  Ninety seven severe stroke patients were prospective recruited from Jan 2011 to Jun 2015. The development of MODS was identified by Sequential Organ Failure Assessment (SOFA) score (score ≥ 3, at least two organs), which was assessed on day 1, 4, 7, 10 and 14 after admission. Baseline characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow coma score (GCS) and cerebral imaging parameters were collected at admission. Cox regression was performed to determine predictors for the development of MODS. Medical complications after admission and in-hospital mortality were also investigated.
  
  
  RESULTS
  33 (34%) patients were in MODS group and 64 (66%) were in non-MODS group within 14 days after admission. Patients in MODS group had more smoker (51.5% vs 28.1%, p = 0.023), higher NIHSS score (23.48 ± 6.12 vs 19.81 ± 4.83, p = 0.004), higher APACHE II score (18.70 ± 5.18 vs 15.64 ± 4.36, p = 0.003) and lower GCS score (6.33 ± 2.48 vs 8.14 ± 2.73, p = 0.002). They also had higher rate of infarction in multi vascular territories (36.4% vs 10.9%, p = 0.003). The most common complication in all patients was pulmonary infection, while complication scores were comparable between two groups. Patients with MODS had higher in-hospital mortality (69.7% vs 9.4%, p = 0.000). In Cox regression, NIHSS score (RR = 1.084, 95% CI 1.019-1.153) and infarction in multi vascular territories (RR = 2.345 95% CI 1.105-4.978) were independent risk factors for development of MODS.
  
  
  CONCLUSIONS
  In acute phase of stroke, NIHSS score and infarction in multi vascular territories predicted MODS in severe stroke patients. Moreover, patients with MODS had higher in-hospital mortality, suggesting that early identification of MODS is critical important.
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qin
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Shuna
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Junliang
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Shujuan
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Wenli
authors.initials: W
authors.lastname: Hu
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*