Evaluación cuantitativa de la disfunción múltiple de órganos por sepsis

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Abstract

Se realiza un estudio prospectivo de 39 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Pediátrico Docente "Ángel Arturo Aballí" durante un período de 16 meses, con el diagnóstico de síndrome de disfunción múltiple de órganos por sepsis. Se hace una evaluación cuantitativa en cada paciente según las alteraciones que conllevaron a la disfunción de órganos y se obtiene de esta forma una puntuación o puntaje individual; se aplica a la puntuación de todos los pacientes la medida de tendencia central o mediana que corresponde a 11 puntos. Resultados: el 85 % de los pacientes fallecidos obtuvo puntuación mayor de 11 (p < 0,01), la mortalidad fue mayor entre los enfermos con 5 ó más órganos afectados (p < 0,01) y en este grupo el 90 % se encontraba por encima de la mediana de los puntos (p < 0,01). La mortalidad alcanza el 92,8 % en los pacientes que evolucionan hasta 3 días en fallo y se encuentran con más de 11 puntos (p < 0,01).

Translated abstract

A prospective study of 39 patients admitted at the Intensive Care Unit of the "Angel Arturo Aballí" Pediatric Teaching Hospital with the diagnosis of multiple organ dysfunction syndrome due to sepsis, was conducted during 16 months. A quantitative evaluation of every patients is made according to the alterations leading to organ dysfunction and thus tan individual scoring is obtained. The measure of central or mean trend corresponding to 11 points is applied to all patients´scoring. Results: 85 % of the dead patients obtained a scoring over 11 (p<0.01), mortality was higher among patients with 5 or more organs effects (p<0.01), and this group 90 % were above the mean score (p<0.01). Mortality amounts to 92.8 % in those patients with failure that are able to evolve up to 3 days and have more than 11 points (p<0.01).

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Most cited references 30

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Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.

J C Marshall, D J Cook, N V Christou … (1995)

To develop an objective scale to measure the severity of the multiple organ dysfunction syndrome as an outcome in critical illness. Systematic literature review; prospective cohort study. Surgical intensive care unit (ICU) of a tertiary-level teaching hospital. All patients (n = 692) admitted for > 24 hrs between May 1988 and March 1990. None. Computerized database review of MEDLINE identified clinical studies of multiple organ failure that were published between 1969 and 1993. Variables from these studies were evaluated for construct and content validity to identify optimal descriptors of organ dysfunction. Clinical and laboratory data were collected daily to evaluate the performance of these variables individually and in aggregate as an organ dysfunction score. Seven systems defined the multiple organ dysfunction syndrome in more than half of the 30 published reports reviewed. Descriptors meeting criteria for construct and content validity could be identified for five of these seven systems: a) the respiratory system (Po2/FIO2 ratio); b) the renal system (serum creatinine concentration); c) the hepatic system (serum bilirubin concentration); d) the hematologic system (platelet count); and e) the central nervous system (Glasgow Coma Scale). In the absence of an adequate descriptor of cardiovascular dysfunction, we developed a new variable, the pressure-adjusted heart rate, which is calculated as the product of the heart rate and the ratio of central venous pressure to mean arterial pressure. These candidate descriptors of organ dysfunction were then evaluated for criterion validity (ICU mortality rate) using the clinical database. From the first half of the database (the development set), intervals for the most abnormal value of each variable were constructed on a scale from 0 to 4 so that a value of 0 represented essentially normal function and was associated with an ICU mortality rate of or = 50%. These intervals were then tested on the second half of the data set (the validation set). Maximal scores for each variable were summed to yield a Multiple Organ Dysfunction Score (maximum of 24). This score correlated in a graded fashion with the ICU mortality rate, both when applied on the first day of ICU admission as a prognostic indicator and when calculated over the ICU stay as an outcome measure. For the latter, ICU mortality was approximately 25% at 9 to 12 points, 50% at 13 to 16 points, 75% at 17 to 20 points, and 100% at levels of > 20 points. The score showed excellent discrimination, as reflected in areas under the receiver operating characteristic curve of 0.936 in the development set and 0.928 in the validation set. The incremental increase in scores over the course of the ICU stay (calculated as the difference between maximal scores and those scores obtained on the first day [i.e., the delta Multiple Organ Dysfunction Score]) also demonstrated a strong correlation with the ICU mortality rate. In a logistic regression model, this incremental increase in scores accounted for more of the explanatory power than admission severity indices. This multiple organ dysfunction score, constructed using simple physiologic measures of dysfunction in six organ systems, mirrors organ dysfunction as the intensivist sees it and correlates strongly with the ultimate risk of ICU mortality and hospital mortality. The variable, delta Multiple Organ Dysfunction Score, reflects organ dysfunction developing during the ICU stay, which therefore is potentially amenable to therapeutic manipulation. (ABSTRACT TRUNCATED)

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Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction.

F Cerra, Peter Beal (1994)

OBJECTIVE--This review of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) provides an overview of a common but complex problem found in critically ill patients. It emphasizes definitions, common clinical patterns, metabolic responses, and pathophysiological changes. A brief discussion of treatment concepts is also included. DATA SOURCES--Data for this review were gathered from peer-reviewed journals, review articles by experts in SIRS/MODS, and selections from reference volumes written on SIRS/MODS. STUDY SELECTION--Reference selections were chosen on the basis of quality of research. Peer-reviewed journals were given primary consideration. Those review articles cited were felt to be essential to any discussion of SIRS/MODS. DATA EXTRACTION--Where possible, randomized, controlled, prospective studies were reviewed and conclusions used in this overview of SIRS/MODS. CONCLUSION--Our ability to care for critically ill patients has led to a new problem, SIRS and eventually MODS, which may become progressive organ failure and death. Unfortunately, these conditions are extremely frequent and carry high mortality rates. Increased oxygen consumption demands highlight the physiological response. The typical metabolic responses are characterized by hyperglycemia and accelerated protein catabolism. Unrecognized perfusion deficits, an uncontrolled septic focus, a persistent source of inflammation, or injured tissue is commonly present with SIRS/MODS and should be corrected. Restoration of oxygen transport and metabolic support are also important components of treatment. The cause of SIRS/MODS is complex and not fully understood, but multiple mediators and stimulated macrophages likely are important components and areas where treatment may well be focused.

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Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma.

Sean P. Parsons, Oliver J. McAnena, Blake Moore … (1991)

Animal studies implicate gut bacterial translocation via the portal vein as a major factor in the pathogenesis of postinjury multiple organ failure (MOF). We therefore inserted portal vein catheters for sequential blood sampling in the operating room, at 6, 12, 24, and 48 hours, and 5 days postoperatively in 20 injured patients (13 blunt, seven penetrating; mean age, 34 years) requiring emergent laparotomy and who were at known risk for MOF. The mean Revised Trauma Score was 6.4 +/- 0.4, and the Injury Severity Score, 29.3 +/- 2.3. Twelve (60%) patients arrived in shock (SBP less than 90 torr). Eight (2%) of 212 portal blood cultures were positive; seven were presumed contaminants. The only positive systemic culture (total, 212) was a Staphylococcus aureus on day 5 in a patient with a concurrent staphyloccal pneumonia. In the first 48 hours, we could not detect endotoxin in portal or systemic blood. Additionally, simultaneous portal and systemic blood levels of complement fragment C3a, tumor necrosis factor, and interleukin-6 were nearly identical and, specifically, were not different in those patients who developed MOF. In summary, this prospective clinical study has not confirmed portal or systemic bacteremia within the first 5 days postinjury, despite an eventual 30% incidence of MOF.

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Author and article information

Journal

Journal ID (publisher-id): ped

Title: Revista Cubana de Pediatría

Abbreviated Title: Rev Cubana Pediatr

Publisher: Centro Nacional de Información de Ciencias Médicas; Editorial Ciencias Médicas (La Habana, , Cuba )

ISSN (Print): 0034-7531

ISSN (Electronic): 1561-3119

Publication date (Print and electronic): June 1998

Volume: 70

Issue: 2

Pages: 67-72

Affiliations

[01] Ciudad de La Habana orgnameHospital Pediátrico Docente Ángel Arturo Aballí Cuba

[02] orgnameInstituto de Medicina del Trabajo.

Article

Publisher ID: S0034-75311998000200001 Publisher ID: S0034-7531(98)07000201

SO-VID: 1936607b-7798-4334-8051-daac5c5a33f3

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 16 June 1997

Date accepted : 16 November 1997

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Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 6

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SciELO Cuba

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Evaluación cuantitativa de la disfunción múltiple de órganos por sepsis

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Abstract

Translated abstract

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SciELO Cuba

Most cited references 30

Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.

Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction.

Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma.

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