Doig Christopher J, Zygun David A, Fick Gordon H, Laupland Kevin B, Boiteau Paul J E, Shahpori Reza, Rosenal Tom, Sandham J Dean
Department of Critical Care Medicine, Unversity of Calgary, Alberta, Canada.
Crit Care Med. 2004 Feb;32(2):384-90. doi: 10.1097/01.CCM.0000108881.14082.10.
Multiple organ dysfunction is a common cause of death in intensive care units. We describe the daily course of multiple organ dysfunction measured by the Sequential Organ Failure Assessment score in a population-based cohort of critically ill patients.
Prospective cohort study.
Adult multisystem intensive care units in the Calgary Health Region.
A total of 1,436 patients admitted from May 1, 2000 to April 30, 2001.
Temporal change in Sequential Organ Failure Assessment score.
None; observational study.
The mean age was 58 yrs (range, 14-100). The mean +/- sd intensive care unit admission Acute Physiology and Chronic Health Evaluation II score was 25 +/- 9. The median intensive care unit length of stay was 4 days (interquartile range, 2-8), and the median hospital length of stay was 15 days (interquartile range, 7-32). A total of 20.5% of patients were infected at admission, and 26.0% were immediately postoperative. Intensive care unit mortality was 27.0%, and hospital mortality was 35.1%. The daily Sequential Organ Failure Assessment score was significantly higher in nonsurvivors than survivors. A population-averaged model determined a mean rate of change of Sequential Organ Failure Assessment score to be -0.29 per day (95% confidence interval, -0.32 to -0.25) for survivors and -0.03 per day (95% confidence interval, -0.08 to 0.03) for nonsurvivors (overall regression, p <.0001). Patients with infection had higher admission Sequential Organ Failure Assessment scores compared with patients without infection (difference, 1.8; p <.001), but a similar rate of daily change.
Multiple organ dysfunction, does not follow a course of progressive and sequential failure. Evidence of differential daily change should further inform the use of organ failure scores as surrogate outcomes in clinical trials.
多器官功能障碍是重症监护病房常见的死亡原因。我们描述了在一个以人群为基础的危重症患者队列中，用序贯器官衰竭评估评分衡量的多器官功能障碍的每日病程。
前瞻性队列研究。
卡尔加里健康地区的成人多系统重症监护病房。
2000年5月1日至2001年4月30日期间共收治1436例患者。
序贯器官衰竭评估评分的时间变化。
无；观察性研究。
平均年龄为58岁（范围14 - 100岁）。重症监护病房入院时急性生理与慢性健康状况评分II的平均值±标准差为25±9。重症监护病房的中位住院时间为4天（四分位间距，2 - 8天），医院的中位住院时间为15天（四分位间距，7 - 32天）。共有20.5%的患者入院时感染，26.0%的患者为术后即刻。重症监护病房死亡率为27.0%，医院死亡率为35.1%。非幸存者的每日序贯器官衰竭评估评分显著高于幸存者。一个总体平均模型确定，幸存者的序贯器官衰竭评估评分平均变化率为每天 -0.29（95%置信区间，-0.32至 -0.25），非幸存者为每天 -0.03（95%置信区间，-0.08至0.03）（总体回归，p <.0001）。与未感染患者相比，感染患者入院时的序贯器官衰竭评估评分更高（差值为1.8；p <.001），但每日变化率相似。
多器官功能障碍并非遵循进行性和序贯性衰竭的病程。每日变化差异的证据应进一步为在临床试验中使用器官衰竭评分作为替代结局提供参考。
