Multiorganic failure at the admission in adult intensive care unit (AICU)

Abstract

Introduction: Multiorganic failure is a frequent and serious complication that affects critical patients in Intensive Care Units. It can be present at the admission time or take place in the evolution during the hospitalisation, being a common cause of death.

Objective: To determine the prevalence of multiorganic failure at the admission time in patients at the Hospital de Clínicas AICU, their demographic and clinical characteristics and risk factors to mortality.

Methods: A descriptive and analytical case control study was conduced from January 2000 to December 2001 at the AICU. All patients with multiorganic failure at the admission time were included. It was used the ODIN score. Other variebles of interest were age, gender, days of stay at the AICU, medical o surgical condition, critical scores at the admission: SAPS II, APACHE II, GALSGOW, SEPTIC and ODIN. There were included OMEGA score, mechanical ventilation, nosocomial infection and mortality, too. Data were processed in Epiinfo version 6, and continuos variables expressed in media with SD, median and percentiles. Chi square test was performed for the comparison of groups. To determine the risk of death, an univariated analysis was done with OR, IC 95% and significance p value <0.05.

Results: Among the 672 patients admitted at the AICU in this period, 417 (62%) had multiorganic failure at the admission time. There were female in 52.2% of cases and the average age was 49±19 years. Critical scores were SAPS II, 41±20; APACHE II, 19±8; GLASGOW, 10±4. The median of stay was 5 days and the OMEGA was 70. Medical conditions were present in 51.6% of the cases and surgical were in 47.7%. Infection was present in 50% of patients at the admission time, and 31.4% of those had septic shock. Ninety three percent (93%) were in mechanical ventilation. Of the total of patients, 24% acquired one or more nosocomial infection during their stay in the unit. Multiorganic failures found at the admission were: respiratory 87%, cardiac failure 74%, infectious 40%, neurological 30%, renal failure 23%, haematologic 9%, gastroenteric failure 6%, hepatic 5%. Mortality was 58% (n:242). Risks factors for mortality with statistical significance in univariated analysis were age >55 years [OR 1.7(1.13-2.62)], medical condition [OR 2.43(1.60-3.70)], SAPS >30 [OR 6.81(4.15-10.95)], APACHE II >15 [OR 6.17(3.86-9.88)], GLASGOW <10 [OR 1.84(1.10-3.09)], septic shock [OR 2.99(1.76-5.08)], mechanical ventilation [OR 13.9(3.92-58.7)], three or more organic failures [OR 3.18(2.08-4.87)], cardiac failure [OR 2.01(1.23-3.27)], respiratory failure [OR 2.2(1.08-4.5)], renal failure [OR 2.33(1.38-3.97)], cardiac and respiratory failure [OR 2.51(1.62-3.92)], all of them with p<0.001.

Conclusion: Multiorganic failure has a high prevalence in patients admitted at the AICU. Most frequent are cardiac and respiratory failures, present in patients with elevated critical Scores. Half of them had an infection at the moment of admission and almost a quarter develops an infection during the stay. Mortality was high with several associated risks factors.