FACTORS RELATED TO MULTIPLE ORGAN SYSTEM FAILURE AND MORTALITY IN A SURGICAL INTENSIVE-CARE UNIT

We retrospectively studied the relative contribution of factors relate d to the extent of multiple organ system failure (MOSF) and mortality, using multivariate methods to account for the interactions between st udied factors, in 538 consecutive patients admitted to a surgical inte nsive care unit during a 1-year period. MOSF (MOSF score greater-than- or-equal-to 5) occurred in 88 (16%) of patients. Multiple linear regre ssion selected advancing age, malnutrition, APACHE II score, shock and coma on admission, number of blood transfusions, use of H-2 receptor antagonists or antacids, bacteraemia and intra-abdominal infection as independent factors related to the MOSF score. MOSF mortality was 52% and was a major cause of death in critically ill surgical patients. Mu ltiple logistic regression selected advancing age, malnutrition, bacte raemia, APACHE II and MOSF score as major predictors of mortality. Adv ancing age, malnutrition, shock and coma on admission, transfusion req uirement and use of H-2 receptor antagonists or antacids may impair ho st defences of the gastrointestinal tract and enhance the vulnerabilit y for invasive infection, thereby aggravating the severity of existing MOSF. Together with the predominance of Enterobacteriaceae in infecte d patients, these results suggest that translocation of intestinal bac teria and endotoxin may be important in the evolution and perpetuating the MOSF syndrome. Our results may be useful in devising strategies t o prevent or limit the evolution of MOSF and to improve survival in pa tients with critical illness.