• Top
• Purpose
• Methods
• Results
• Conclusions
• References

Purpose

To correlate the occurrence and level of organ dysfunction in ARDS with mortality.

Methods

This cohort study includes all consecutive patients with ARDS criteria [1] admitted in the ICU between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at the ARDS diagnosis, the occurrence of organ dysfunction determined by the multiple organ dysfunction syndrome (MODS) [2] in the first week, and mortality in the ICU. The occurrence of organ/system dysfunction was considered with a MODS equal to or greater than 1 in any day. The levels 3 or 4 of MODS were considered severe organ/system dysfunction. Statistical analyses were done by Mann-Whitney and chi-square as indicated.

Results

There was 141 patients (P) with ARDS criteria and all were included in the analysis. Seventy-six (54%) were men, the mean age was 46 ± 18 years and APACHE II 19 ± 7. Mortality rate was 79%. In survivors (SV) and nonsurvivors (NSV) mean age was 35 ± 14 years and 49 ± 5 years (P < 0.0001), and APACHE II 16 ± 5 and 20 ± 7 (P < 0.001), respectively. There was no difference about gender in mortality. In all groups, there was 4.3 ± 1 organ dysfunction, with 10 P (7%) with 2, 20 P(14%)3, 36 P(26%)4, 69 P(49%)5, and 6 P(4%)6 organ/system dysfunction; mortality rate in these groups was, respectively: 50%, 60%, 81%, 87% and 100%. The number of organ/system dysfunction was in SV 3.7 ± 1.1 and in NSV 4.5 ± 0.9 (P < 0.01). The global MODS in the first week in SV and NSV was: 6 ± 2.5 and 8.8 ± 3.1^*; 5.8 ± 2.6 and 9 ± 3.5^*; 5.9 ± 2.8 and 9 ± 3.5^*; 4.9 ± 2.6 and 8.8 ± 3.7^*; 4.3 ± 2.7 and 8.6 ± 3.7^*; 4.3 ± 3.2 and 8.6 ± 3.6^*; 5.2 ± 3.6 and 7.2 ± 3.7^**, respectively (^*P < 0.0001; ^**P = 0.035). Bivariate analysis of each organ of MODS in separate in the first week vs mortality showed that renal dysfunction was present in 94 P(89%) and 12 P(11%) (P < 0.001) and haematological dysfunction in 96 P(86%) and 16 P(14%) (P < 0.01), in NSV and SV. Severe cardiovascular dysfunction was present in 79 P(85%) NSV and in 14(15%) SV (P < 0.03). The other variables showed no statistical differences.

Conclusions

The occurrence, level and number of organ/systems compromised in the first week after ARDS, estimated by the MODS, correlated with mortality in our patients. Cardiovascular, renal and hematological dysfunctions were those more influents in mortality; the determination of neurological dysfunction was difficult because patients were sedated for mechanical ventilation. In our patients, mortality was affected by age and the severity of organ dysfunction in the first week, estimated by the MODS.

References

1. Bernard GR, Artigas A, Brigham KL, et al.:

   Am Respir Crit Care Med 1994, 149:818-824.

2. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ:

   Crit Care Med 1995, 23:1638-1652. PubMed Abstract | Publisher Full Text

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