TY - JOUR
T1 - Changing pattern of organ dysfunction in early human sepsis is related to mortality
AU - Russell, James A.
AU - Singer, Joel
AU - Bernard, Gordon R.
AU - Wheeler, Arthur
AU - Fulkerson, William
AU - Hudson, Leonard
AU - Schein, Roland
AU - Summer, Warren
AU - Wright, Patrick
AU - Walley, Keith R.
PY - 2000
Y1 - 2000
N2 - 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.
AB - 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.
KW - Organ dysfunction
KW - Organ failure
KW - Scoring systems
KW - Sepsis syndrome
UR - http://www.scopus.com/inward/record.url?scp=0033787234&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033787234&partnerID=8YFLogxK
U2 - 10.1097/00003246-200010000-00005
DO - 10.1097/00003246-200010000-00005
M3 - Article
C2 - 11057793
AN - SCOPUS:0033787234
VL - 28
SP - 3405
EP - 3411
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 10
ER -