Analysis of morbimortality in patients with multiorgan dysfunction

Introduction

Multiorgan dysfunction syndrome (MODS) is often the final complication in critical patients. The increasing incidence of MODS has been linked to development of resuscitation and support techniques. The study aims were to describe the etiology, morbimortality rate and mortality causes of MODS, and to find factors associated with this syndrome.

Methods

A prospective cohort study including 296 nonselected medical critically ill patients diagnosed with multiorgan failure (SOFA score ≥ 3 in at least two organs) and admitted to a 24-bed ICU of a tertiary hospital from January to June 2007.

Results

Two hundred and ninety-six patients were admitted, 124 suffered from MODS and 72% of them had it at admission. Fifty-nine percent came from the emergency room. The mean age was 59 ± 16.2 years, and 60% were male. Causes of admission: 26% neurologic pathology, 23% sepsis and 17% respiratory pathology. Most frequent cause of MODS was sepsis (55%). Other causes were respiratory pathology (13%) and neurologic impairment (14%). At admission, 66.2% showed one (19.4%) or two (46.8%) failing organs. Four or more failing organs were found in 10% of patients at admission. During their stay in the ICU, 24.4% showed four or more failing organs and almost 50% of them showed two failing organs. Severity: APACHE II score 24.6 ± 7, APACHE III score 79.4 ± 29, SAPS II score 55.57 ± 15, SAPS III score 72 ± 14; SOFA score at admission 10 ± 3, SOFA score in 24 hours 9.3 ± 4, SOFA score in 48 hours 8.3 ± 3; SOFA score in 72 hours 7.6 ± 3.7, SOFA maximum score 12.4 ± 3.8. Outcome complications in 62%. Mean stay in the ICU was 9.7 ± 11.1 days and in the hospital was 20 ± 19 days. The mortality rate in the ICU was 50% and in hospital was 59%. Patients with severe respiratory failure had higher mortality rates (63% vs 40%, χ² P = 0.05). The mortality rate in the hospital increased with the number of failing organs (patients with four or more failing organs showed 90% mortality, χ² P = 0.000). Patients who developed complications had higher mortality rates (76.3% vs 30.4%, χ² P = 0.000), except for nosocomial pneumonia. Severity score systems and sequential SOFA scores were found to be independent predictor factors of mortality.

Conclusion

Critically ill patients who show MODS have a high mortality rate, especially if they suffer from respiratory failure or had four or more failing organs. In this study, severity score shows a good discriminatory power.