Faculdade de Medicina de São José do Rio Preto, Serviço de Terapia Intensiva do Hospital de Base e Laboratório de Sepse, Avenida Brigadeiro Faria Lima, 5544 CEP 15090-000 São Jose do Rio Preto, SP, Brazil.
Anesth Analg. 2011 Apr;112(4):877-83. doi: 10.1213/ANE.0b013e3181e2bf8e. Epub 2010 Jun 8.
Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. However, these patients frequently die as a consequence of primary or secondary multiple organ failure (MOF), often as a result of sepsis. We investigated the early perioperative risk factors for in-hospital death due to MOF in surgical patients.
This was a prospective, multicenter, observational cohort study performed in 21 Brazilian intensive care units (ICUs). Adult patients undergoing noncardiac surgery who were admitted to the ICU within 24 hours after operation were evaluated. MOF was characterized by the presence of at least 2 organ failures. To determine the relative risk (RR) of in-hospital death due to MOF, we performed a logistic regression multivariate analysis.
A total of 587 patients were included (mean age, 62.4 ± 17 years). ICU and hospital mortality rates were 15% and 20.6%, respectively. The main cause of death was MOF (53%). Peritonitis (RR 4.17, 95% confidence interval [CI] 1.38-12.6), diabetes (RR 3.63, 95% CI 1.17-11.2), unplanned surgery (RR 3.62, 95% CI 1.18-11.0), age (RR 1.04, 95% CI 1 0.01-1.08), and elevated serum lactate concentrations (RR 1.52, 95% CI 1.14-2.02), a high central venous pressure (RR 1.12, 95% CI 1.04-1.22), a fast heart rate (RR 3.63, 95% CI 1.17-11.2) and pH (RR 0.04, 95% CI 0.0005-0.38) on the day of admission were independent predictors of death due to MOF.
MOF is the main cause of death after surgery in high-risk patients. Awareness of the risk factors for death due to MOF may be important in risk stratification and can suggest routes for therapy.
预测围手术期心脏并发症对于接受非心脏手术的患者的医学管理非常重要。然而，这些患者经常因原发性或继发性多器官衰竭（MOF）而死亡，通常是由于败血症引起的。我们研究了手术患者住院期间因 MOF 导致的早期围手术期死亡的危险因素。
这是一项在巴西 21 个重症监护病房（ICU）进行的前瞻性、多中心、观察性队列研究。评估在手术后 24 小时内入住 ICU 的非心脏手术成年患者。MOF 的特征是至少有 2 个器官衰竭。为了确定因 MOF 导致的住院死亡的相对风险（RR），我们进行了多变量逻辑回归分析。
共纳入 587 例患者（平均年龄 62.4 ± 17 岁）。ICU 和医院死亡率分别为 15%和 20.6%。主要死亡原因是 MOF（53%）。腹膜炎（RR 4.17，95%置信区间[CI] 1.38-12.6）、糖尿病（RR 3.63，95% CI 1.17-11.2）、计划外手术（RR 3.62，95% CI 1.18-11.0）、年龄（RR 1.04，95% CI 1.01-1.08）和血清乳酸浓度升高（RR 1.52，95% CI 1.14-2.02）、高中心静脉压（RR 1.12，95% CI 1.04-1.22）、快速心率（RR 3.63，95% CI 1.17-11.2）和入院当天 pH 值（RR 0.04，95% CI 0.0005-0.38）是 MOF 导致死亡的独立预测因子。
MOF 是高危患者手术后死亡的主要原因。了解 MOF 死亡的危险因素对于风险分层可能很重要，并提示治疗途径。
