A COMPARISON OF RISKS AND OUTCOMES FOR PATIENTS WITH ORGAN SYSTEM FAILURE - 1982-1990

Objectives: To compare the outcomes for patients with one or more orga n system failures treated in 1988 to 1990 with those outcomes from 197 9 to 1982; to document risk factors for developing organ system failur e; and investigate the relationship of these factors to hospital survi val. Design: Prospective, multicenter, inception cohort analysis. Sett ing: Sixty intensive care units (ICUs) at 53 U.S. hospitals. Patients: A total of 17,440 ICU admissions treated in 1988 to 1990 and 5,677 IC U admissions treated in 1979 to 1982. Interventions: None. Measurement s and Main Results: At the time of organ system failure, patients were classified by demographic, physiologic, and diagnostic information, T he type and number of organ system failures and physiologic responses were recorded for less than or equal to 7 days of ICU treatment, and a ll patients were followed for status at hospital discharge, Hospital s urvival and the prognostic value of assessing the number of organ syst em failures were compared with risk assessment, based on use of a prog nostic scoring system that estimated the patient's probability of hosp ital mortality. The incidence of organ system failure (48%) among pati ents treated in 1988 to 1990 was similar (44%) to the occurrence rate in patients in 1979 to 1982; and an identical proportion (14%) develop ed multiple organ system failure. There was a significant (p < .0003) improvement in hospital mortality for patients with three or more orga n system failures on day 4 or later of organ system failure, However, overall hospital mortality rates from multiple organ system failure we re not different over this 8-yr period, The most important predictor o f hospital mortality was the severity of physiologic disturbance on th e initial day of failure. Discrimination of patients by risk of hospit al mortality was better using the prognostic scoring system on day 1 o f organ system failure (receiver operating characteristic curve = 0.88 ) than using a model based on the number of organ system failures (rec eiver operating characteristic curve = 0.68). Conclusions: Organ syste m failure remains a major contributor to death in patients in ICUs, Th e incidence and overall outcome have not significantly changed over th e past 8 yrs, but there has been significant improvement in survival f or patients with persistent severe organ system failure, A continuous measure of individual patient severity of illness is a more sensitive and accurate method for describing patients and estimating outcome tha n counting the number of organ system failures.