Changing pattern of organ dysfunction in early human sepsis is related to mortality

James A. Russell, Joel Singer, Gordon R. Bernard, Arthur Wheeler, William Fulkerson, Leonard Hudson, Roland Schein, Warren Summer, Patrick Wright, Keith R. Walley

Research output: Contribution to journalArticle

146 Scopus citations

Abstract

Objective: We examined the pattern of organ system dysfunction, the evolution of this pattern over time, and the relationship of these features to mortality in patients who had sepsis syndrome. Design: Prospective, multicenter, observational study. Setting: Intensive care units in tertiary referral teaching hospitals. Patients: A total of 287 patients who had sepsis syndrome were prospectively identified in intensive care units. Materials and Measurements: Cardiovascular, pulmonary, neurologic, coagulation, renal, and hepatic dysfunction were assessed at onset and on day 3 of sepsis syndrome. Organ dysfunction was classified as normal, mild, moderate, severe, and extreme dysfunction. We calculated the occurrence rate and associated 30-day mortality rate of organ dysfunction at the onset of sepsis syndrome. We then measured the change in organ dysfunction from onset to day 3 of sepsis syndrome and determined, for individual organ systems, the associated 30-day mortality rate. Results: At the onset of sepsis syndrome, clinically significant pulmonary dysfunction was the most common organ failure, but was not related to 30-day mortality. Clinically significant cardiovascular, neurologic, coagulation, renal, and hepatic dysfunction were less common at the onset of sepsis syndrome but were significantly associated with the 30-day mortality rate. Worsening neurologic, coagulation, and renal dysfunction from onset to day 3 of sepsis syndrome were associated with significantly higher 30-day mortality than with improvement or no change in organ dysfunction. Conclusions: Increased mortality rate in sepsis syndrome is associated with a pattern characterized by failure of nonpulmonary organ systems and, in particular, worsening neurologic, coagulation, and renal dysfunction over the first 3 days. Although initial pulmonary dysfunction is common in patients with sepsis syndrome, it is not associated with an increased mortality rate.

Original languageEnglish (US)
Pages (from-to)3405-3411
Number of pages7
JournalCritical care medicine
Volume28
Issue number10
DOIs
StatePublished - Jan 1 2000

Keywords

  • Organ dysfunction
  • Organ failure
  • Scoring systems
  • Sepsis syndrome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Changing pattern of organ dysfunction in early human sepsis is related to mortality'. Together they form a unique fingerprint.

  • Cite this

    Russell, J. A., Singer, J., Bernard, G. R., Wheeler, A., Fulkerson, W., Hudson, L., Schein, R., Summer, W., Wright, P., & Walley, K. R. (2000). Changing pattern of organ dysfunction in early human sepsis is related to mortality. Critical care medicine, 28(10), 3405-3411. https://doi.org/10.1097/00003246-200010000-00005