Time course of organ dysfunction comparing survivors and nonsurvivors: results of the multicentric study 'Sepsis occurrence in the acutely ill patients' (SOAP)

Introduction

Multiple organ dysfunction syndrome (MODS) is the main reason for death in septic patients. Most scoring systems are aimed to calculate a sum parameter for estimating the individual risk of the patient. This analysis describes the time course of organ dysfunction comparing survivors and nonsurvivors.

Methods

A total of 3147 patients (198 centers from 24 countries) were included. The time period preceding the day of fatal outcome (nonsurvivors) or ICU discharge (survivors) was analyzed and plotted versus the severity of organ dysfunction (SOFA) and the number of patients (3D histogram). In addition, the SOFA points of each organ system were calculated over time, considering reproducible time patterns of survivors versus nonsurvivors.

Results

The ICU mortality rate was 18.5%. The overall time course of organ dysfunction was as shown in Fig. 1.

Figure 1

Analysis of single organ scores revealed that a cardiac failure was preceding in the majority of nonsurvivors, whereas other early organ dysfunctions were only rarely found. In contrast, the severity of organ dysfunction decreased towards discharge in surviving patients.

Conclusion

This analysis demonstrates that 1) most survivors had only minor organ dysfunction (one or two organ failures), and 2) early cardiac failure is typical in nonsurvivors.