Organ dysfunction influences outcome in medical oncology patients without multiorgan failure

Introduction

In a previous audit, patients with ≤ 1 organ failure (OF) on day 1 or day 2 had high ICU mortality (63% and 52%, respectively). We examined the impact of organ dysfunction (OD) patients with ≤ 1 OF.

Methods

One hundred and seventy-nine consecutive adult admissions (111 males, 68 females) from February 2006 to June 2007 with an ICU stay ≥ 3 days were prospectively studied. The APACHE II score, day 1 SOFA score, highest SOFA score of the first three days (MAX3), and changes in SOFA score between day 2 and day 1 (Δ1) and between day 3 and day 1 (Δ2) were calculated. For each organ, a SOFA score of 1–2 or 3–4 defined OD or OF, respectively. The total number of ODs and OFs on ICU days 1–3 was calculated. Binary logistic regression (backward conditional) was used to determine factors associated with mortality.

Results

The mean age was 44.8 ± 15.4 years, APACHE II score 20.1 ± 6.5 and SOFA score 16.8 ± 3.8. The ICU mortality was 66%. On days 1 and 2, 65% and 77% patients had ≤ 1 OF. On days 1–3, an increasing number of ODs were significantly associated with increasing mortality in patients with ≤ 1 OF, but not in patients with ≥ 2 OFs (Table 1). On multivariate analysis, Δ2 (OR = 1.26, 95% CI = 1.12–1.41, P = 0.000), ODs on day 1 (OR = 1.54, CI = 1.06–2.23, P = 0.03) and OFs on day 2 (OR = 2.67, CI = 1.76–4.06) were independently associated with ICU mortality.

Table 1 (abstract P491)

Conclusion

An increasing number of ODs worsens the outcome in critically ill medical oncology patients with ≤ 1 OF. Worsening OD scores are associated with mortality. Early recognition and management of OD before the onset of multiple OF may help improve outcome.