Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome
Identifieur interne : 000617 ( Main/Exploration ); précédent : 000616; suivant : 000618Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome
Auteurs : Yasser Sakr [Allemagne] ; Suzana M. Lobo [Brésil] ; Rui P. Moreno [Portugal] ; Herwig Gerlach [Allemagne] ; V Marco Ranieri [Italie] ; Argyris Michalopoulos [Grèce] ; Jean-Louis Vincent [Belgique]Source :
- Critical Care [ 1364-8535 ] ; 2012.
Abstract
Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome.
Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score.
A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%,
Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis.
Url:
DOI: 10.1186/cc11868
PubMed: 23158219
PubMed Central: 3672601
Affiliations:
- Allemagne, Belgique, Brésil, Grèce, Italie, Portugal
- Berlin, Piémont, Vienne (Autriche), État de São Paulo
- Berlin, São Paulo, Turin, Vienne (Autriche)
- Université libre de Bruxelles
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Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome</title><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena</wicri:regionArea><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion></affiliation></author><author><name sortKey="Lobo, Suzana M" sort="Lobo, Suzana M" uniqKey="Lobo S" first="Suzana M" last="Lobo">Suzana M. Lobo</name><affiliation wicri:level="3"><nlm:aff id="I2">Division of Critical Care Medicine, Department of Internal Medicine, Medical School-FUNFARME and Hospital de Base, São José do Rio Preto, São Paulo, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Division of Critical Care Medicine, Department of Internal Medicine, Medical School-FUNFARME and Hospital de Base, São José do Rio Preto, São Paulo</wicri:regionArea><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Moreno, Rui P" sort="Moreno, Rui P" uniqKey="Moreno R" first="Rui P" last="Moreno">Rui P. Moreno</name><affiliation wicri:level="1"><nlm:aff id="I3">Dunidade de Cuidados Intensivos Neurocriticos, Hospital de São José, Centro Hospitalar de Lisboa Central, E.P.E., Rua José António Serrano, 1150-199 Lisbon, Portugal</nlm:aff><country xml:lang="fr">Portugal</country><wicri:regionArea>Dunidade de Cuidados Intensivos Neurocriticos, Hospital de São José, Centro Hospitalar de Lisboa Central, E.P.E., Rua José António Serrano, 1150-199 Lisbon</wicri:regionArea><wicri:noRegion>1150-199 Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Gerlach, Herwig" sort="Gerlach, Herwig" uniqKey="Gerlach H" first="Herwig" last="Gerlach">Herwig Gerlach</name><affiliation wicri:level="3"><nlm:aff id="I4">Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukölln, Rudower Strasse 48, D-12313 Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukölln, Rudower Strasse 48, D-12313 Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Ranieri, V Marco" sort="Ranieri, V Marco" uniqKey="Ranieri V" first="V Marco" last="Ranieri">V Marco Ranieri</name><affiliation wicri:level="3"><nlm:aff id="I5">Department of Anesthesia and Critical Care, Ospedale S. Giovanni Battista-Molinette, corso Dogliotti 14, 10126, University of Turin, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care, Ospedale S. Giovanni Battista-Molinette, corso Dogliotti 14, 10126, University of Turin, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Michalopoulos, Argyris" sort="Michalopoulos, Argyris" uniqKey="Michalopoulos A" first="Argyris" last="Michalopoulos">Argyris Michalopoulos</name><affiliation wicri:level="1"><nlm:aff id="I6">Intensive Care Unit, Henry Dunant Hospital, Department of Medicine, Athens, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Intensive Care Unit, Henry Dunant Hospital, Department of Medicine, Athens</wicri:regionArea><wicri:noRegion>Athens</wicri:noRegion></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="4"><nlm:aff id="I7">Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Brussels, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Brussels</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23158219</idno><idno type="pmc">3672601</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672601</idno><idno type="RBID">PMC:3672601</idno><idno type="doi">10.1186/cc11868</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">000160</idno><idno type="wicri:Area/Pmc/Curation">000158</idno><idno type="wicri:Area/Pmc/Checkpoint">000078</idno><idno type="wicri:Area/Ncbi/Merge">000338</idno><idno type="wicri:Area/Ncbi/Curation">000338</idno><idno type="wicri:Area/Ncbi/Checkpoint">000338</idno><idno type="wicri:doubleKey">1364-8535:2012:Sakr Y:patterns:and:early</idno><idno type="wicri:Area/Main/Merge">000617</idno><idno type="wicri:Area/Main/Curation">000617</idno><idno type="wicri:Area/Main/Exploration">000617</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome</title><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena</wicri:regionArea><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion></affiliation></author><author><name sortKey="Lobo, Suzana M" sort="Lobo, Suzana M" uniqKey="Lobo S" first="Suzana M" last="Lobo">Suzana M. Lobo</name><affiliation wicri:level="3"><nlm:aff id="I2">Division of Critical Care Medicine, Department of Internal Medicine, Medical School-FUNFARME and Hospital de Base, São José do Rio Preto, São Paulo, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Division of Critical Care Medicine, Department of Internal Medicine, Medical School-FUNFARME and Hospital de Base, São José do Rio Preto, São Paulo</wicri:regionArea><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Moreno, Rui P" sort="Moreno, Rui P" uniqKey="Moreno R" first="Rui P" last="Moreno">Rui P. Moreno</name><affiliation wicri:level="1"><nlm:aff id="I3">Dunidade de Cuidados Intensivos Neurocriticos, Hospital de São José, Centro Hospitalar de Lisboa Central, E.P.E., Rua José António Serrano, 1150-199 Lisbon, Portugal</nlm:aff><country xml:lang="fr">Portugal</country><wicri:regionArea>Dunidade de Cuidados Intensivos Neurocriticos, Hospital de São José, Centro Hospitalar de Lisboa Central, E.P.E., Rua José António Serrano, 1150-199 Lisbon</wicri:regionArea><wicri:noRegion>1150-199 Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Gerlach, Herwig" sort="Gerlach, Herwig" uniqKey="Gerlach H" first="Herwig" last="Gerlach">Herwig Gerlach</name><affiliation wicri:level="3"><nlm:aff id="I4">Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukölln, Rudower Strasse 48, D-12313 Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukölln, Rudower Strasse 48, D-12313 Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Ranieri, V Marco" sort="Ranieri, V Marco" uniqKey="Ranieri V" first="V Marco" last="Ranieri">V Marco Ranieri</name><affiliation wicri:level="3"><nlm:aff id="I5">Department of Anesthesia and Critical Care, Ospedale S. Giovanni Battista-Molinette, corso Dogliotti 14, 10126, University of Turin, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care, Ospedale S. Giovanni Battista-Molinette, corso Dogliotti 14, 10126, University of Turin, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Michalopoulos, Argyris" sort="Michalopoulos, Argyris" uniqKey="Michalopoulos A" first="Argyris" last="Michalopoulos">Argyris Michalopoulos</name><affiliation wicri:level="1"><nlm:aff id="I6">Intensive Care Unit, Henry Dunant Hospital, Department of Medicine, Athens, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Intensive Care Unit, Henry Dunant Hospital, Department of Medicine, Athens</wicri:regionArea><wicri:noRegion>Athens</wicri:noRegion></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="4"><nlm:aff id="I7">Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Brussels, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Route de Lennik 808, 1070 Brussels</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome.</p></sec><sec><title>Methods</title><p>Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score.</p></sec><sec><title>Results</title><p>A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, <italic>P </italic>< 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors.</p></sec><sec><title>Conclusions</title><p>Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Seely, Aj" uniqKey="Seely A">AJ Seely</name></author><author><name sortKey="Christou, Nv" uniqKey="Christou N">NV Christou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name></author><author><name sortKey="Sakr, Y" uniqKey="Sakr Y">Y Sakr</name></author><author><name sortKey="Sprung, Cl" uniqKey="Sprung C">CL Sprung</name></author><author><name sortKey="Ranieri, Vm" uniqKey="Ranieri V">VM Ranieri</name></author><author><name sortKey="Reinhart, K" uniqKey="Reinhart K">K Reinhart</name></author><author><name sortKey="Gerlach, H" uniqKey="Gerlach H">H Gerlach</name></author><author><name sortKey="Moreno, R" uniqKey="Moreno R">R Moreno</name></author><author><name sortKey="Carlet, J" uniqKey="Carlet J">J 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sortKey="Schein, Rm" uniqKey="Schein R">RM Schein</name></author><author><name sortKey="Sibbald, Wj" uniqKey="Sibbald W">WJ Sibbald</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Russell, Ja" uniqKey="Russell J">JA Russell</name></author><author><name sortKey="Singer, J" uniqKey="Singer J">J Singer</name></author><author><name sortKey="Bernard, Gr" uniqKey="Bernard G">GR Bernard</name></author><author><name sortKey="Wheeler, A" uniqKey="Wheeler A">A Wheeler</name></author><author><name sortKey="Fulkerson, W" uniqKey="Fulkerson W">W Fulkerson</name></author><author><name sortKey="Hudson, L" uniqKey="Hudson L">L Hudson</name></author><author><name sortKey="Schein, R" uniqKey="Schein R">R Schein</name></author><author><name sortKey="Summer, W" uniqKey="Summer W">W Summer</name></author><author><name sortKey="Wright, P" uniqKey="Wright P">P Wright</name></author><author><name sortKey="Walley, Kr" uniqKey="Walley K">KR Walley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levy, Mm" uniqKey="Levy M">MM Levy</name></author><author><name sortKey="Macias, Wl" uniqKey="Macias W">WL Macias</name></author><author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name></author><author><name sortKey="Russell, Ja" uniqKey="Russell J">JA Russell</name></author><author><name sortKey="Silva, E" uniqKey="Silva E">E Silva</name></author><author><name sortKey="Trzaskoma, B" uniqKey="Trzaskoma B">B Trzaskoma</name></author><author><name sortKey="Williams, Md" uniqKey="Williams M">MD Williams</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cabre, L" uniqKey="Cabre L">L Cabre</name></author><author><name sortKey="Mancebo, J" uniqKey="Mancebo J">J Mancebo</name></author><author><name sortKey="Solsona, Jf" uniqKey="Solsona J">JF Solsona</name></author><author><name sortKey="Saura, P" uniqKey="Saura P">P Saura</name></author><author><name sortKey="Gich, I" uniqKey="Gich I">I Gich</name></author><author><name sortKey="Blanch, L" uniqKey="Blanch L">L Blanch</name></author><author><name sortKey="Carrasco, G" uniqKey="Carrasco G">G Carrasco</name></author><author><name sortKey="Martin, Mc" uniqKey="Martin M">MC Martin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dulhunty, Jm" uniqKey="Dulhunty J">JM Dulhunty</name></author><author><name sortKey="Lipman, J" uniqKey="Lipman J">J Lipman</name></author><author><name sortKey="Finfer, S" uniqKey="Finfer S">S Finfer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guidet, B" uniqKey="Guidet B">B Guidet</name></author><author><name sortKey="Aegerter, P" uniqKey="Aegerter P">P Aegerter</name></author><author><name sortKey="Gauzit, R" uniqKey="Gauzit R">R Gauzit</name></author><author><name sortKey="Meshaka, P" uniqKey="Meshaka P">P Meshaka</name></author><author><name sortKey="Dreyfuss, D" uniqKey="Dreyfuss D">D Dreyfuss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Umegaki, T" uniqKey="Umegaki T">T Umegaki</name></author><author><name sortKey="Ikai, H" uniqKey="Ikai H">H Ikai</name></author><author><name sortKey="Imanaka, Y" uniqKey="Imanaka Y">Y Imanaka</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>Brésil</li><li>Grèce</li><li>Italie</li><li>Portugal</li></country><region><li>Berlin</li><li>Piémont</li><li>Vienne (Autriche)</li><li>État de São Paulo</li></region><settlement><li>Berlin</li><li>São Paulo</li><li>Turin</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université libre de Bruxelles</li></orgName></list><tree><country name="Allemagne"><noRegion><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name></noRegion><name sortKey="Gerlach, Herwig" sort="Gerlach, Herwig" uniqKey="Gerlach H" first="Herwig" last="Gerlach">Herwig Gerlach</name></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Lobo, Suzana M" sort="Lobo, Suzana M" uniqKey="Lobo S" first="Suzana M" last="Lobo">Suzana M. Lobo</name></region></country><country name="Portugal"><noRegion><name sortKey="Moreno, Rui P" sort="Moreno, Rui P" uniqKey="Moreno R" first="Rui P" last="Moreno">Rui P. Moreno</name></noRegion></country><country name="Italie"><region name="Piémont"><name sortKey="Ranieri, V Marco" sort="Ranieri, V Marco" uniqKey="Ranieri V" first="V Marco" last="Ranieri">V Marco Ranieri</name></region></country><country name="Grèce"><noRegion><name sortKey="Michalopoulos, Argyris" sort="Michalopoulos, Argyris" uniqKey="Michalopoulos A" first="Argyris" last="Michalopoulos">Argyris Michalopoulos</name></noRegion></country><country name="Belgique"><region name="Vienne (Autriche)"><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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