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Impact of Preoperative Organ Failures on Survival in Intensive Care Unit Patients with Colectomy

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Abstract

Background

The present study aimed to evaluate the prognostic value of preoperative changes in sequential organ failure assessment (SOFA) score, daily norepinephrine (NE) dose, lactate, C-reactive protein, and white blood cell count among patients with colectomy in the intensive care unit (ICU).

Methods

We performed a retrospective analysis of 77 colectomized patients (30 female, 47 male) who were treated in a single tertiary-level mixed ICU during 2000–2009.

Results

The underlying conditions leading to colectomy included sepsis (31 patients), cardiovascular operations (21 patients), and fulminant Clostridium difficile colitis (25 patients). The 28-day mortality was 53.3 % (41/77). Nonsurvivors had significantly higher median values than survivors (p < 0.05) for the following parameters: admission SOFA [10.0 (25th–75th percentile 8.0–13.0) vs. 9.0 (6.5–10.0)], highest SOFA [14.0 (12.0–16.0) vs. 12.5 (9.5–14.5)], operative day lactate level (6.3 vs. 2.2 mmol/L), and NE dose (16.8 vs. 9.3 total mg/day). During the last three preoperative days, significant increases were observed in total SOFA score (p < 0.001) and in cardiovascular (p < 0.001), coagulation (p = 0.017), renal (p < 0.01), and respiratory (p < 0.001) SOFA subscores, without statistically significant differences between nonsurvivors and survivors. Increasing Glasgow Coma Scale score, preoperative lactate level, and NE dose were significantly associated with mortality.

Conclusions

It should be prospectively studied whether preoperatively increasing lactate level and NE dose are surrogate markers for early laparotomy among ICU patents with colitis.

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Authors and Affiliations

  1. Division of Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, PO Box 21, 90029, Oulu, Finland

    Seija Sipola, Jouko J. Laurila, Pasi Ohtonen & Tero I. Ala-Kokko

  2. Department of Infection Control, Oulu University Hospital, 90029, Oulu, Finland

    Hannu Syrjälä

  3. Department of Surgery, Oulu University Hospital, 90029, Oulu, Finland

    Vesa Koivukangas & Juha Saarnio

Authors
  1. Seija Sipola
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  2. Hannu Syrjälä
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  3. Vesa Koivukangas
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  4. Jouko J. Laurila
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  5. Pasi Ohtonen
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  6. Juha Saarnio
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  7. Tero I. Ala-Kokko
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Correspondence to Seija Sipola.

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Sipola, S., Syrjälä, H., Koivukangas, V. et al. Impact of Preoperative Organ Failures on Survival in Intensive Care Unit Patients with Colectomy. World J Surg 37, 1647–1651 (2013). https://doi.org/10.1007/s00268-013-2041-6

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  • DOI: https://doi.org/10.1007/s00268-013-2041-6

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