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Author Notes:

Andre L. Holder, MD, MS, Assistant Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive SE, Rm 2D012, Atlanta, GA 30303, Phone: 404.616.0823, Fax: 404.616.8455, andre.holder@emory.edu

Conflicts of interest: The remaining authors have disclosed that they do not have any remaining conflicts of interest.

Subjects:

Research Funding:

Dr. Holder received support from CR Bard.

Dr. Kempker receives support from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000454 and KL2 TR000455).

Dr. Nemati is supported by the National Institute of Environmental Health Sciences of the NIH (K01 ES025445).

Dr. Martin received funding from Bard, Grifols (Medical Advisory Boards) and received support for article research from the NIH. His institution received funding from the NIH, Food and Drug Administration (FDA), and Baxter Healthcare. He is supported by the National Institute for General Medical Sciences (R01 GM113228), and the National Center for Advancing Translational Sciences of the NIH (UL1 TR000454).

Dr. Buchman is an investigator in the Surgical Critical Care Initiative (http://www.SC2i.org), a federally funded activity administered through the Henry M. Jackson Foundation for the Advancement of Military Medicine (http://www.hjf.org). He is also the Editor-in-Chief of Critical Care Medicine.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Critical Care Medicine
  • General & Internal Medicine
  • intensive care unit
  • mortality
  • organ failure
  • prognostication
  • sepsis
  • EMERGENCY-DEPARTMENT PATIENTS
  • INTENSIVE-CARE UNITS
  • ASSESSMENT SCORE
  • SOFA SCORE
  • SEPSIS
  • MULTICENTER
  • DYSFUNCTION/FAILURE
  • MORTALITY
  • METAANALYSIS

Serial Daily Organ Failure Assessment Beyond ICU Day 5 Does Not Independently Add Precision to ICU Risk-of-Death Prediction

Tools:

Journal Title:

Critical Care Medicine

Volume:

Volume 45, Number 12

Publisher:

, Pages 2014-2022

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objectives: To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients. Design: Retrospective cohort study, with external validation in a deidentified ICU database. Setting: Eleven ICUs in three university hospitals within an academic healthcare system in 2014. Patients: Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation. Intervention: None Measurements and Main Results: Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p < 0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance. Conclusions: Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis.

Copyright information:

© 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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