Factors related to multiple organ system failure and mortality in a surgical intensive care unit.

ABSTRACT

We retrospectively studied the relative contribution of factors related to the extent of multiple organ system failure (MOSF) and mortality, using multivariate methods to account for the interactions between studied factors, in 538 consecutive patients admitted to a surgical intensive care unit during a 1-year period. MOSF (MOSF score > or = 5) occurred in 88 (16%) of patients. Multiple linear regression selected advancing age, malnutrition, APACHE II score, shock and coma on admission, number of blood transfusions, use of H2 receptor antagonists or antacids, bacteraemia and intra-abdominal infection as independent factors related to the MOSF score. MOSF mortality was 52% and was a major cause of death in critically ill surgical patients. Multiple logistic regression selected advancing age, malnutrition, bacteraemia, APACHE II and MOSF score as major predictors of mortality. Advancing age, malnutrition, shock and coma on admission, transfusion requirement and use of H2 receptor antagonists or antacids may impair host defences of the gastrointestinal tract and enhance the vulnerability for invasive infection, thereby aggravating the severity of existing MOSF. Together with the predominance of Enterobacteriaceae in infected patients, these results suggest that translocation of intestinal bacteria and endotoxin may be important in the evolution and perpetuating the MOSF syndrome. Our results may be useful in devising strategies to prevent or limit the evolution of MOSF and to improve survival in patients with critical illness.