Organ dysfunction as a prognostic indicator

It is a basic truism of intensive care that the sickest patients are those who are most likely to die during their ICU course. Application of this principle to the task of risk prediction in the ICU led to the development of dedicated prognostic scores, each of which was developed using statistical approaches that maximized predictive capability.

A scale that grades increasing degrees of organ system dysfunction will of necessity have some predictive capacity. If 80 per cent of all deaths in the ICU result from multiple organ dysfunction syndrome, then 20 per cent of ICU deaths occur in the absence of significant degrees of organ dysfunction, and a scale that has been designed to maximize construct validity should not have the prognostic power of a scale that has been designed to predict mortality.

Nonetheless, the degree of organ dysfunction early during the ICU stay is an important determinant of the ultimate risk of ICU mortality. Organ dysfunction scores calculated within the first 24 h of ICU admission are highly associated with ultimate risk of mortality, ranging from 2 per cent for patients with a score of zero to 100 per cent for patients with a score of 13 or higher (Marshall etal 1995). Quantification of the degree of organ dysfunction at the time of admission can provide an objective measure of the severity of the syndrome in those patients in whom it is present and therefore could be a useful means of stratifying patients at the outset of clinical trials or of quantifying initial severity of illness in disease processes such as intra-abdominal infection where organ dysfunction is an important outcome.

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