Chest
Volume 132, Issue 3, September 2007, Pages 829-835
Journal home page for Chest

ORIGINAL RESEARCH
CRITICAL CARE MEDICINE
Nonpulmonary Organ Dysfunction and Its Impact on Outcome in Patients With Acute Respiratory Failure

https://doi.org/10.1378/chest.06-2783Get rights and content

Purpose

This study aimed to define the prevalence, severity, and progression of nonpulmonary organ dysfunction, and its impact on outcome in patients with acute respiratory failure (ARF) at a respiratory ICU of a tertiary referral hospital in northern India.

Methods

Daily patient data were collected on 711 adult patients with ARF to calculate component and total nonpulmonary sequential organ failure assessment (SOFA) scores. Hospital survival was the main outcome measure. Multiple logistic regression modeling was conducted to assess contribution of incremental dysfunction of various nonpulmonary organ systems to mortality. Kaplan-Meier curves were drawn to assess temporal trends in survival, and group comparisons were based on log-rank test. Cox proportional hazard modeling was performed to define hazards of earlier mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.

Results

Four hundred seventy-five patients (66.8%) had one or more nonpulmonary organ dysfunctions at hospital admission. The overall hospital mortality rate was 33.9%. Hospital survival rates and median survival declined steadily as the number of organs involved increased. Admission, maximum, and ΔSOFA scores were significantly higher in nonsurvivors. Increasing baseline cardiovascular and neurologic SOFA scores, and corresponding ΔSOFA scores, were associated with progressively higher odds of hospital mortality, as well as increasing hazard for earlier mortality after adjustment for etiology of respiratory failure. Maximum nonpulmonary SOFA score was the best discriminator in predicting mortality (area under ROC curve, 0.767).

Conclusion

Baseline and new-onset nonpulmonary organ dysfunction significantly influences hospital survival in patients with ARF.

Section snippets

Materials and Methods

We prospectively recorded demographic, clinical, laboratory, and therapeutic data from hospital admission to discharge on all adult patients (aged ≥ 15 years) with ARF managed at our RICU over a 5-year period. The study was approved by our hospital ethics committee. Data were registered on hospital admission and every 24 h thereafter, using the worst daily values for all variables of interest. Day 0 was defined as the interval from time of RICU admission to 8:00 am the next day; data from this

Results

Data from 711 RICU admissions (428 men [60.2%] and 283 women [39.8%]) were analyzed. More than half (53.7%) required respiratory support for either ARDS or acute exacerbation of bronchial asthma or COPD (Table 1). The overall hospital mortality rate was 33.9%, with highest rates for patients with ARDS (Table 1). Of these, 14 deaths occurred in wards after patients had been transferred out of the RICU. On initial evaluation, 475 patients (66.8%) had at least one nonpulmonary organ dysfunction,

Discussion

Organ dysfunction is a continuum, from normal organ function, through varying degrees of organ dysfunction, to severe organ failure, and alters over the duration of patient's ICU stay. While clinicians understand the need to describe and quantify organ dysfunction, there is no consensus on the exact modality to do so. The SOFA is one such widely used instrument that not only describes severity of organ dysfunction, but also provides an aggregate score as a measure of morbidity related to organ

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    The authors have no conflicts of interest to disclose.

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