Prognosis of critically ill patients with multiple organ failure

The purpose of this study was to determine the mortality rate in 527 critically ill patients with multiple organ failure (MOF), treated in our ICU between August, 1986 and January, 1992, and to compare it with the results obtained in a group of patients studied who had been treated between October, 1978 and July, 1986. The relationship between the mortality rate and each type of organ failure and the extent of organ system involvement was also investigated. The overall mortality rate was 25%, and the rate increased with the number of failed organs. Sepsis and disseminated intravascular coagulation were closely associated with the development of MOF. The mortality rate of patients with the failure of two organs in the present study was significantly lower than that found in those in the previous study. Although artificial organ mechanical life support technology other than that for patients with renal failure is still unsatisfactory, these results suggest that the prognosis of patients with MOF is improving.

Non-neurologic organ dysfunction in severe traumatic brain injury

OBJECTIVE

To describe the incidence of non-neurologic organ dysfunction and its association with outcome in patients with severe traumatic brain injury admitted to intensive care.

DESIGN

Observational cohort study.

SETTING

Foothills Medical Centre, which is the only neurosurgical service in southern Alberta (population approximately 1.3 million).

PATIENTS

Patients were 209 consecutive patients with severe traumatic brain injury.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Non-neurologic organ dysfunction was measured by the maximum modified multiple organ dysfunction score. Organ system failure was defined as a component score of >/=3 on any day during the patient's intensive care unit stay. One hundred and eighty-five patients (89%) developed dysfunction of at least one non-neurologic organ system. Ninety-six organ system failures were identified in 74 patients (35%). Respiratory failure was the most common non-neurologic organ system failure, occurring in 23% of patients, whereas cardiovascular failure occurred in 18%. Eight patients (4%) had failure of the coagulation system. One patient had renal failure, whereas no patient developed hepatic failure. In a multivariate model, non-neurologic organ dysfunction was independently associated with hospital mortality (odds ratio for hospital mortality, 1.63; 95% confidence interval, 1.34, 1.98 for one maximum modified multiple organ dysfunction score point). Non-neurologic organ dysfunction was also independently associated with dichotomized Glasgow Outcome Score, as a measure of neurologic outcome (odds ratio for unfavorable neurologic outcome, 1.53; 95% confidence interval, 1.22, 1.98 for one maximum modified multiple organ dysfunction score point). The timing of the organ dysfunction did not appear to be important in the prediction of outcome.

CONCLUSIONS

Non-neurologic organ dysfunction is common in patients with severe traumatic brain injury and is independently associated with worse outcome.