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Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making

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Abstract

Objective

This study examined the incidence and mortality of multiple organ dysfunction syndrome (MODS) in intensive care units, evaluated the limitation of life support in these patients, and determined whether daily measurement of the Sequential Organ Failure Assessment (SOFA) is useful for decision making.

Design and setting

Prospective, observational study in 79 intensive care units.

Patients and participants

Of the 7,615 patients admitted during a 2-month period we found 1,340 patients to have MODS.

Measurements and results

We recorded mortality and length of stay in the intensive care unit and the hospital and the maximum and minimum total SOFA scores during MODS. Limitation of life support in MODS patients was also evaluated. Stepwise logistic regression was used to determine the factors predicting mortality. The in-hospital mortality rate in patients with MODS was 44.6%, and some type of limitation of life support was applied in 70.6% of the patients who died. The predictive model maximizing specificity included the following variables: maximum SOFA score, minimum SOFA score, trend of the SOFA for 5 consecutive days, and age over 60 years. The model diagnostic yield was: specificity 100%, sensitivity 7.2%, positive predictive value 100%, and negative predictive value 57.3%; the area under the receiver operating characteristic curve was 0.807.

Conclusions

This model showed that in our population with MODS those older than 60 years and with SOFA score higher than 9 for at least 5 days were unlikely to survive.

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References

  1. American College of Chest Physicians/Society of Critical Care Medicine (1992) Consensus Conference: definitions for sepsis and multiple organ failure. Crit Care Med 20:864–874

    Google Scholar 

  2. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bostos PG, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A (1991) The APACHE III prognostic system-risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1639

    Google Scholar 

  3. Le Gall JR, Lemeshow S, Saunier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Google Scholar 

  4. Lemeshow S, Teres D, FLAR J, Avrunin JS, Gehlbach SH, Rapaport J (1993) Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270:2478–2486

    Google Scholar 

  5. Marshall JC, COOK DJ, Christou NV, Bernard GR, Sprung ChL, Sibbald WJ (1995) The multiple organ dysfunction (MOD) score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652

    Google Scholar 

  6. Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The logistic organ dysfunction system. A new way to assess organ dysfunction in intensive care unit. JAMA 276:802–810

    Google Scholar 

  7. Vincent JL, de Mendonca A, Cantraune F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ system dysfunction/failure in intensive care units: results of a multi-center, prospective study. Crit Care Med 26:1793–1800

    Google Scholar 

  8. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286:1754–1758

    Google Scholar 

  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 202:685–693

    Google Scholar 

  10. Prendergast TJ, Luce JM (1997) Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med 155:15–20

    Google Scholar 

  11. Turner JS, Michel WL, Morgan CJ, Benatar SR (1996) Limitation of life support: frequency and practice in a London and a Cape Town intensive care unit. Intensive Care Med 22:1020–1025

    Google Scholar 

  12. Esteban A, Gordo F, Solsona JF, Alia I, Caballero J, Bouza C, Alcala-Zamora J, Cook DJ, Sanchez JM, Abizanda R, Miró G, Fernández Del Cabo MJ, de Miguel E, Santos JA, Balerdi BL (2001) Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-center observational study. Intensive Care Med 27:1744–1749

    Google Scholar 

  13. Keenan SP, Busche KD, Chen LM, McCarthy L, Ininan KJ, Sibbald WJ (1997) A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support. Crit Care Med 25:1324–1331

    Google Scholar 

  14. Saura P, Cabré L, Solsona F, Gichs I, Mancebo J (2002) Spanish study of organ dysfunction and its evaluation with the daily SOFA score. Intensive Care Med 28 [Suppl 1]:S143

  15. Tran DD, Groeneveld ABJ, ven der Meulen J, Nauta JJ, Strack van Schijndel RJ, thies LG (1990) Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med 18:474–479

    Google Scholar 

  16. De Campo MM, Demling RH (1988) Posttraumatic multisystem organ failure. JAMA 260:530–534

    Google Scholar 

  17. Beal AL, Cerra FB (1994) Multiple organ failure syndrome in the 1990’s systemic inflammatory response and organ dysfunction. JAMA 271:226–233

    Google Scholar 

  18. Garcia F, Manzano JL, González B, Fuentes J, Saavedra P (2000) Supervivencia y calidad de vida de los pacientes con fracaso multiorgánico al año del alta de una unidad de medicina intensiva. Med Clin (Barc) 114 [Suppl 3]:99–103

  19. Abizanda R, Almendros L, Balerdi B, Socias L, López J, Valle FX (1994) Limitación del esfuerzo terapéutico. Encuesta sobre el estado de opinión de los profesionales de la Medicina Intensiva 18:100–105

  20. World Federation of Societies of Intensive and Critical Care Medicine (1992) Ethical principles in intensive care. Ethical guidelines. Intensive Crit Care Dig 11:40–41

    Google Scholar 

  21. President’s Comisión for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983) Deciding to forgo life-sustaining treatment: ethical, medical and legal issues in treatment decisions. United States Government Printing Office, Washington

  22. Appleton International Conference (1992) Developing guidelines for decisions to forgo life-prolonging medical treatment. J Med Ethics 18 [Suppl]:10–15

    Google Scholar 

  23. American Collage of physicians (1998) Ethics manual. Ann Intern Med 128:576–594

    Google Scholar 

  24. Callahan D (1990) What kind of life: the limits of medical progress. Simon and Schuster, New York,

    Google Scholar 

  25. Cabré Ll, Costa J, carrasco G, Molina R (1996) Sistemas de puntuación de gravedad. Mortalidad. Revista Calidad Asistencial 11:47–53

    Google Scholar 

  26. Villar J, Manzano JJ, Blázquez MA, Quintana J, Lubillo S (1991) Multiple system organ failure in acute respiratory failure. J Crit Care 6:75–80

    Google Scholar 

  27. Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoza A, Passariello M, Riccioni L, Osborn J, SOFA Group (1999) Application of SOFA score to trauma patients. Intensive Care Med 25:389–394

    Google Scholar 

  28. Mendoza A, Vincent JL, Suter PM, Moreno R, Dearden NB, Antonelli M, Takala J, Sprung CL, Cantraine F (2000) Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 26:915–921

    Google Scholar 

  29. Janssens U, Graf C, Graf J, Radke PW, Königs B, Koch KC, Lepper W, vom Dahl J, Hanrath P (2000) Evaluation of the SOFA score: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders. Intensive Care Med 26:1037–1045

    Google Scholar 

  30. Moreno R, Vincent JL, Matos R, Mendoza A, Cantraine F, Thies L, Takala J, Sprung C, Antonelli M, Bruining H, Willattson S (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicenter study. Intensive Care Med 25:686–696

    Google Scholar 

  31. Pettila V, Pettila M, Sarna S, Voutilainen P, Takkunen O (2002) Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med 30:1705–1711

    Google Scholar 

  32. Smedira NG, Evans BH, Grais LS, Cohen NH, Lo B, Cooke M, Schecter WP, Fine C, Epstein-Jaffe E, May C, Luce M (1990) Withholding and withdrawal of life support from the critically ill. N Engl J Med 322:309–315

    Google Scholar 

  33. Cabré Ll, Solsona F, Grupo de Trabajo de Bioética de la SEMICYUC (2002) Limitación del esfuerzo terapéutico en medicina intensiva. Med Intensiva 26:304–311

    Google Scholar 

  34. Carlet J, Thies LG, Antonelli M, Cassell J, Cox P, Hill N, Hinds C, Pimentel JM, Reinhart K, Thompson BT (2004) Challenges in end-of-life care in the ICU. Statement of the 5th international consensus conference in critical care: Brussels, Belgium, April 2004. Intensive Care Med 30:770–784

    Google Scholar 

  35. Giannini A, Pessina A, Tacchi EM (2003) End of life decisions in intensive care units: attitudes of physicians in an Italian urban setting. Intensive Care Med 29:1902–1910

    Google Scholar 

  36. Azoulay E, Pochard F, Garrouste-Orgeas M, Moreau D, Montesino L, Adrie C, Lassence A, Cohen Y, Timsit JF (2003) Decisions to forgo life-sustaining therapy in ICU patients independently predict hospital death. Intensive Care Med 29:1895–1901

    Google Scholar 

Download references

Acknowledgements

We thank all those professionals who contributed in data collection in the many centers taking part in the study. This study was made possible by a grant from the Grifols Bioethics Foundation. Participating colleages and centers were: M. Guirado, Centre Hospitalari de Manresa, Manresa, Barcelona. J.L. Monzón, Complejo Hospitalario San Millán-San Pedro Logroño, Logroño; F. Fernández, Clínica Delfos, Barcelona; J. Puig, Clínica Quirón, Barcelona; P. Santigosa, Clínica Sagrada Familia, Barcelona; J.M. Urtasun, Clínica San Miguel, Pamplona, Navarra; M.A. Fernández, Complejo Hospitalario Xeral-Calde, Lugo; M.A. Alcalá, Fundación Jimenez Díaz, Madrid; J.C. Montejo, Hospital 12 de Octubre, Madrid; E. Campo, Hospital Alto Guadalquivir Andujar, Jaén; F. Alberdi, Hospital Donostia, San Sebastián, Guipuzcoa; E. Molina, Hospital Can Misses, Ibiza, Baleares; J. Ruiz, Hospital Casa de Salud, Valencia; Instituto Nacional de Silicosis, Asturias; J.M. Nicolás, Hospital Clínic (AVI), Barcelona; E. Carrero, Hospital Clínic (UCIQ), Barcelona; A. Torres, J.R. Badía, Hospital Clínic (UVIR), Barcelona; J. Blanquer, Hospital Clínic Universitari, Valencia; L. Salvo, Hospital Clínico Universitario Lozano Blesa, Zaragoza; Z. MedíZ, Hospital Comarcal de Antequera, Antequera, Málaga; J. Lloréns, Hospital Comarcal Vinaròs, Vinaròs, Castellón; J. Berrade, Hospital Creu Roja Hospitalet L’Hospitalet de Llobregat, Barcelona; L.I. Cabré, Hospital de Barcelona, Barcelona; M. Lacort, Hospital de Cabueñes, Cabueñes, Gijón; R. Abizanda, Hospital de Castellón, Castellón; M. Casanovas, Hospital de Igualada, Igualada, Barcelona; I. Morán, Hospital de la Santa Creu i Sant Pau Barcelona; F. Esteban, Hospital de Reus, Reus, Tarragona; J.A. Maldonado, Hospital de Ronda, Ronda, Málaga; M.J. Broch, Hospital de Sagunto, Puerto Sagunto, Valencia; I. Roldán, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona; L. Cristóbal, Hospital de Valme, Sevilla; F. Solsona, Hospital del Mar Barcelona; M.C. Martín, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona; L. Socías, Fundación Hospital Son Llàtzer, Palma Mallorca, Baleares Islands; J.M. Campos, Hospital General de Segovia, Segovia; G. Jiménez, Hospital General de Soria, Soria; J. Boada, Hospital General de Vic, Vic, Barcelona; M. Frutos, Hospital General de Yagüe, Burgos; F.J. García Rodríguez, Hospital General Universitario Carlos Haya Málaga; A. Robles, ICU of the Traumatology and Rehabilitation Area, Hospitals Vall d’Hebron, Barcelona; R. Rubio, Hospital Gregorio Marañon, Madrid; M. Robles, J.A. Figueroa, Hospital Infanta Cristina, Badajoz; D. Rovira, L. Barcellona, Hospital Italiano de Rosario, Rosario, Argentina; B. Hernández, Hospital La Merced Osuna, Seville; X. Balanzó, Hospital Mataró, Mataró, Barcelona; T. Mas, Hospital Clínic (Liver ICU), Barcelona; I. Osten, Hospital Miguel Pérez Carreno, Venezuela; A. Carrillo, Hospital Morales Meseguer, Murcia; S. Quintana, Hospital Mutua Terrasa, Terrassa, Barcelona; L.I. Blanch, Hospital Parc Taulí Sabadell, Barcelona; A. Diaz-Prieto, Hospital Príncipes de España, L’Hospitalet de Llobregat, Barcelona; J.A. Cambronero, Hospital Príncipe de Asturias Alcalá de Henares, Madrid; J. López, Hospital Río Carrión, Palencia; A. Molina, Hospital San Agustín, Linares, Jaén; M. Valledor, Hospital San Agustín Avilés, Asturias; R. Ortega, Hospital San Juan Bautista, Catamarca, Argentina; J.M. Allegue, Hospital Santa Maria del Rosell, Cartagena, Murcia; P. Jubert, Hospital Santa Tecla, Tarragona; F. Nogal, Hospital Severo Ochoa, Leganés, Madrid; M.J. Alvarez, Hospital Terrasa, Terrassa, Barcelona; S. Iribarren, Hospital Txagorritxu, Vitoria Gasteiz; J. Trujillano, Hospital Universitari Arnau de Vilanova, Lleida; J. Canet, Hospital Universitari Germans Trias i Pujol (REA), Badalona, Barcelona; J. Sánchez-Andrade, Hospital Universitari Germans Trias i Pujol (ICU), Badalona, Barcelona; A. Abella, Hospital Universitario de Getafe, Getafe, Madrid; R. Sierra, Hospital Universitario Puerta del Mar, Cádiz; A. Sánchez, Hospital Universitario San Juan de Alicante San Juan, Alicante; R. Fernández-Cid, Hospital Verge del Toro, Maó, Menorca, Baleares; M. López, Hospital Virgen Macarena, Seville; A. Monteagudo, Instituto Valenciano Oncología, Valencia; H. Escanda, Sanatorio Cantegril Maldonado, Uruguay; F. Manzano, Hospital Virgen de las Nieves, Granada; S. Roig, Hospital Son Dureta, Palma Mallorca, Balearic Islands; S. Armengol, Hospital Granollers, Granollers, Barcelona; R. Corcuera, Hospital Sagrat Cor, Barcelona; I. Cejudo, Hospital Sta Mª Naí, Complejo Hospitalario Ourense, Ourense; O. Luque, Clinica Sta Mª Asunción, Tolosa, Guipuzcoa; Clínica Nª Sra. Perpetuo Socorro, Las Palmas, Gran Canaria.

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Authors and Affiliations

  1. Hospital de Barcelona, SCIAS, Diagonal 660, 08034, Barcelona, Spain

    L. Cabré & G. Carrasco

  2. Hospital Sant Pau, Barcelona, Spain

    J. Mancebo & I. Gich

  3. Hospital del Mar, Barcelona, Spain

    J. F. Solsona

  4. Hospital Parc Taulí, Sabadell, Barcelona, Spain

    P. Saura & L. Blanch

  5. Hospital General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain

    M. C. Martín

Authors
  1. L. Cabré
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  2. J. Mancebo
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  3. J. F. Solsona
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  4. P. Saura
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  5. I. Gich
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  6. L. Blanch
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  7. G. Carrasco
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  8. M. C. Martín
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and the Bioethics Working Group of the SEMICYUC

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Correspondence to L. Cabré.

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Cabré, L., Mancebo, J., Solsona, J.F. et al. Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making. Intensive Care Med 31, 927–933 (2005). https://doi.org/10.1007/s00134-005-2640-2

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