Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization
P. S. Barie and L. J. Hydo
Department of Surgery, Cornell University Medical College, New York, NY, USA.
BACKGROUND: Multiple organ dysfunction syndrome (MODS) is the leading cause
of death in the general surgery intensive care unit (SICU). The development
of MODS is a powerful predictor of prolonged SICU stay in survivors and
nonsurvivors of critical illness, but its relation to less severe illness
and briefer duration of care is unknown. OBJECTIVES: To determine the
relation between modest degrees of MODS and length of stay in the SICU and
hospital and whether daily MOD score calculations can distinguish survivors
from nonsurvivors before the SICU stay becomes prolonged. SETTING: An SICU
of a university tertiary care medical center. DESIGN: Prospective
inception-cohort study. Illness severity data were collected in retrospect
only for the calendar year 1991. PATIENTS: Of 2646 consecutive patients
studied, 115 stayed in the SICU more than 21 days. METHODS: Acute
Physiology and Chronic Health Evaluation (APACHE) II and III scores were
calculated after 24 hours, with daily and cumulative MOD scores (0-4 points
for 6 organs, 24 points maximum). Patients were followed up until hospital
discharge or death. Data analysis was performed by unpaired 2-tailed t
test, exact contingency analysis for multiple groups, univariate 1- or
2-way analysis of variance with repeated measures, or linear or polynomial
regression tests as appropriate, alpha = .05. RESULTS: The mean (+/-SEM)
age of the patients was 65 +/- 1 years; mean (+/-SEM) APACHE II score, 13.8
+/- 0.2; APACHE III score, 44.2 +/- 0.7; incidence of MODS, 1173 of 2646
patients, 44.3%; and hospital mortality rate, 9.2%. Cumulative MOD scores
correlated closely with SICU length of stay in survivors, especially for
SICU stays of less than 10 days (R2 = 0.99, P < .001). Similar
correlations existed between the prevalence of MODS related to the
increasing length of the SICU stay (R2 = 0.98, P < .001) and between the
length of hospital stay and the cumulative MOD score (R2 = 0.79, P <
.05). Daily MOD scores in patients whose SICU stay was more than 21 days
distinguished survivors from nonsurvivors by day 2 of the SICU stay (P <
.05) and thereafter. CONCLUSIONS: Modest degrees of MODS correlate closely
with the duration of care in less severely ill patients. Early
identification and daily quantitation of MODS may help identify patients at
risk for prolonged illness and death. Prevention of outcomes that
contribute to organ dysfunction is critical for reduction of length of stay
and cost of care.
