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Intensive Care Medicine

, Volume 31, Issue 7, pp 927–933 | Cite as

Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making

  • L. CabréEmail author
  • J. Mancebo
  • J. F. Solsona
  • P. Saura
  • I. Gich
  • L. Blanch
  • G. Carrasco
  • M. C. Martín
  • and the Bioethics Working Group of the SEMICYUC
Original

Abstract

Objective

This study examined the incidence and mortality of multiple organ dysfunction syndrome (MODS) in intensive care units, evaluated the limitation of life support in these patients, and determined whether daily measurement of the Sequential Organ Failure Assessment (SOFA) is useful for decision making.

Design and setting

Prospective, observational study in 79 intensive care units.

Patients and participants

Of the 7,615 patients admitted during a 2-month period we found 1,340 patients to have MODS.

Measurements and results

We recorded mortality and length of stay in the intensive care unit and the hospital and the maximum and minimum total SOFA scores during MODS. Limitation of life support in MODS patients was also evaluated. Stepwise logistic regression was used to determine the factors predicting mortality. The in-hospital mortality rate in patients with MODS was 44.6%, and some type of limitation of life support was applied in 70.6% of the patients who died. The predictive model maximizing specificity included the following variables: maximum SOFA score, minimum SOFA score, trend of the SOFA for 5 consecutive days, and age over 60 years. The model diagnostic yield was: specificity 100%, sensitivity 7.2%, positive predictive value 100%, and negative predictive value 57.3%; the area under the receiver operating characteristic curve was 0.807.

Conclusions

This model showed that in our population with MODS those older than 60 years and with SOFA score higher than 9 for at least 5 days were unlikely to survive.

Keywords

Multiple organ dysfunction syndrome Limiting life support 

Notes

Acknowledgements

We thank all those professionals who contributed in data collection in the many centers taking part in the study. This study was made possible by a grant from the Grifols Bioethics Foundation. Participating colleages and centers were: M. Guirado, Centre Hospitalari de Manresa, Manresa, Barcelona. J.L. Monzón, Complejo Hospitalario San Millán-San Pedro Logroño, Logroño; F. Fernández, Clínica Delfos, Barcelona; J. Puig, Clínica Quirón, Barcelona; P. Santigosa, Clínica Sagrada Familia, Barcelona; J.M. Urtasun, Clínica San Miguel, Pamplona, Navarra; M.A. Fernández, Complejo Hospitalario Xeral-Calde, Lugo; M.A. Alcalá, Fundación Jimenez Díaz, Madrid; J.C. Montejo, Hospital 12 de Octubre, Madrid; E. Campo, Hospital Alto Guadalquivir Andujar, Jaén; F. Alberdi, Hospital Donostia, San Sebastián, Guipuzcoa; E. Molina, Hospital Can Misses, Ibiza, Baleares; J. Ruiz, Hospital Casa de Salud, Valencia; Instituto Nacional de Silicosis, Asturias; J.M. Nicolás, Hospital Clínic (AVI), Barcelona; E. Carrero, Hospital Clínic (UCIQ), Barcelona; A. Torres, J.R. Badía, Hospital Clínic (UVIR), Barcelona; J. Blanquer, Hospital Clínic Universitari, Valencia; L. Salvo, Hospital Clínico Universitario Lozano Blesa, Zaragoza; Z. MedíZ, Hospital Comarcal de Antequera, Antequera, Málaga; J. Lloréns, Hospital Comarcal Vinaròs, Vinaròs, Castellón; J. Berrade, Hospital Creu Roja Hospitalet L’Hospitalet de Llobregat, Barcelona; L.I. Cabré, Hospital de Barcelona, Barcelona; M. Lacort, Hospital de Cabueñes, Cabueñes, Gijón; R. Abizanda, Hospital de Castellón, Castellón; M. Casanovas, Hospital de Igualada, Igualada, Barcelona; I. Morán, Hospital de la Santa Creu i Sant Pau Barcelona; F. Esteban, Hospital de Reus, Reus, Tarragona; J.A. Maldonado, Hospital de Ronda, Ronda, Málaga; M.J. Broch, Hospital de Sagunto, Puerto Sagunto, Valencia; I. Roldán, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona; L. Cristóbal, Hospital de Valme, Sevilla; F. Solsona, Hospital del Mar Barcelona; M.C. Martín, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona; L. Socías, Fundación Hospital Son Llàtzer, Palma Mallorca, Baleares Islands; J.M. Campos, Hospital General de Segovia, Segovia; G. Jiménez, Hospital General de Soria, Soria; J. Boada, Hospital General de Vic, Vic, Barcelona; M. Frutos, Hospital General de Yagüe, Burgos; F.J. García Rodríguez, Hospital General Universitario Carlos Haya Málaga; A. Robles, ICU of the Traumatology and Rehabilitation Area, Hospitals Vall d’Hebron, Barcelona; R. Rubio, Hospital Gregorio Marañon, Madrid; M. Robles, J.A. Figueroa, Hospital Infanta Cristina, Badajoz; D. Rovira, L. Barcellona, Hospital Italiano de Rosario, Rosario, Argentina; B. Hernández, Hospital La Merced Osuna, Seville; X. Balanzó, Hospital Mataró, Mataró, Barcelona; T. Mas, Hospital Clínic (Liver ICU), Barcelona; I. Osten, Hospital Miguel Pérez Carreno, Venezuela; A. Carrillo, Hospital Morales Meseguer, Murcia; S. Quintana, Hospital Mutua Terrasa, Terrassa, Barcelona; L.I. Blanch, Hospital Parc Taulí Sabadell, Barcelona; A. Diaz-Prieto, Hospital Príncipes de España, L’Hospitalet de Llobregat, Barcelona; J.A. Cambronero, Hospital Príncipe de Asturias Alcalá de Henares, Madrid; J. López, Hospital Río Carrión, Palencia; A. Molina, Hospital San Agustín, Linares, Jaén; M. Valledor, Hospital San Agustín Avilés, Asturias; R. Ortega, Hospital San Juan Bautista, Catamarca, Argentina; J.M. Allegue, Hospital Santa Maria del Rosell, Cartagena, Murcia; P. Jubert, Hospital Santa Tecla, Tarragona; F. Nogal, Hospital Severo Ochoa, Leganés, Madrid; M.J. Alvarez, Hospital Terrasa, Terrassa, Barcelona; S. Iribarren, Hospital Txagorritxu, Vitoria Gasteiz; J. Trujillano, Hospital Universitari Arnau de Vilanova, Lleida; J. Canet, Hospital Universitari Germans Trias i Pujol (REA), Badalona, Barcelona; J. Sánchez-Andrade, Hospital Universitari Germans Trias i Pujol (ICU), Badalona, Barcelona; A. Abella, Hospital Universitario de Getafe, Getafe, Madrid; R. Sierra, Hospital Universitario Puerta del Mar, Cádiz; A. Sánchez, Hospital Universitario San Juan de Alicante San Juan, Alicante; R. Fernández-Cid, Hospital Verge del Toro, Maó, Menorca, Baleares; M. López, Hospital Virgen Macarena, Seville; A. Monteagudo, Instituto Valenciano Oncología, Valencia; H. Escanda, Sanatorio Cantegril Maldonado, Uruguay; F. Manzano, Hospital Virgen de las Nieves, Granada; S. Roig, Hospital Son Dureta, Palma Mallorca, Balearic Islands; S. Armengol, Hospital Granollers, Granollers, Barcelona; R. Corcuera, Hospital Sagrat Cor, Barcelona; I. Cejudo, Hospital Sta Mª Naí, Complejo Hospitalario Ourense, Ourense; O. Luque, Clinica Sta Mª Asunción, Tolosa, Guipuzcoa; Clínica Nª Sra. Perpetuo Socorro, Las Palmas, Gran Canaria.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • L. Cabré
    • 1
    Email author
  • J. Mancebo
    • 2
  • J. F. Solsona
    • 3
  • P. Saura
    • 4
  • I. Gich
    • 2
  • L. Blanch
    • 4
  • G. Carrasco
    • 1
  • M. C. Martín
    • 5
  • and the Bioethics Working Group of the SEMICYUC
  1. 1.Hospital de BarcelonaSCIASBarcelonaSpain
  2. 2.Hospital Sant PauBarcelonaSpain
  3. 3.Hospital del MarBarcelonaSpain
  4. 4.Hospital Parc TaulíSabadell, BarcelonaSpain
  5. 5.Hospital General de CatalunyaSant Cugat del Vallés, BarcelonaSpain

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