Nonpulmonary organ dysfunction and its impact on outcome in patients with acute respiratory failure

作者：Aggawal Ashutosh N; Agarwal Ritesh; Gupta Dheeraj; Jindal Surinder K^*

来源：Chest, 2007, 132(3): 829-835.

DOI：10.1378/chest.06-2783

• hospital mortality
• multiple organ failure
• multivariate analysis
• respiratory insufficiency
• severity of illness

Purpose: This study aimed to define the prevalence, severity, and progression of nonpulmonary organ dysfunction, and its impact on outcome in patients with acute respiratory failure (ARF) at a respiratory ICU of a tertiary referral hospital in northern India.
Methods: Daily patient data were collected on 711 adult patients with ARF to calculate component and total nonpulmonary sequential organ failure assessment (SOFA) scores. Hospital survival was the main outcome measure. Multiple logistic regression modeling was conducted to assess contribution of incremental dysfunction of various nonpulmonary organ systems to mortality. Kaplan-Meier curves were drawn to assess temporal trends in survival, and group comparisons were based on log-rank test. Cox proportional hazard modeling was performed to define hazards of earlier mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.
Results: Four hundred seventy-five patients (66.8%) had one or more nonpulmonary organ dysfunctions at hospital admission. The overall hospital mortality rate was 33.9%. Hospital survival rates and median survival declined steadily as the number of organs involved increased. Admission, maximum, and Delta SOFA scores were significantly higher in nonsurvivors. Increasing baseline cardiovascular and neurologic SOFA scores, and corresponding Delta SOFA scores, were associated with progressively higher odds of hospital mortality, as well as increasing hazard for earlier mortality after adjustment for etiology of respiratory failure. Maximum nonpulmonary SOFA score was the best discriminator in predicting mortality (area under ROC curve, 0.767).
Conclusion: Baseline and. new-onset nonpulmonary organ dysfunction significantly influences hospital survival in patients with ARF.

• 出版日期2007-9
• 单位河北医科大学