Surgery pp 305-320 | Cite as

Risk Prediction and Outcome Description in Critical Surgical Illness

  • John C. Marshall

Abstract

The first half of the twentieth century brought a number of important advances in the ability of the surgeon to care for the critically ill or multiply injured patient. An understanding of the critical role of fluid resuscitation in the treatment of shock, the development of blood transfusion, the development of techniques to monitor and support the circulation, the introduction of parenteral nutritional support, and the development of positive pressure mechanical ventilation and hemodialysis all served to reduce the mortality for wartime trauma from close to 100% at the turn of the century to less than 5% by the time of the Vietnam War.1 Rapid death from acute physiological insufficiency gave way to uncomplicated recovery for some; for others, it opened the door to an entirely new series of problems—the sequelae of life-threatening physiological instability and of the deleterious consequences of the interventions employed to sustain life during a period of otherwise lethal organ system insufficiency. Known as the multiple organ dysfunction syndrome (MODS),2 this panoply of clinical problems has emerged as the leading unsolved problem in the management of the critically ill.

Keywords

Dopamine Creatinine Pancreatitis Neuropathy Stratification 

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References

  1. 1.
    Root HD. The way we were: 1989 presidential address, American Association for the surgery of trauma. J Trauma 1990; 30: 1309–1315.PubMedGoogle Scholar
  2. 2.
    Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101: 1644–1655.PubMedGoogle Scholar
  3. 3.
    Knaus WA, Wagner DP, Lynn J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science 1991; 254: 389–394.PubMedGoogle Scholar
  4. 4.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.PubMedGoogle Scholar
  5. 5.
    Le Gall J-R, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270: 2957–2963.PubMedGoogle Scholar
  6. 6.
    Lemeshow S, Klar J, Teres D, Avrunin JS, Gehlbach SH, Rapoport J, Rue M. Mortality probability models for patients in the intensive care unit for 48 or 72 hours: a prospective, multicenter study. Crit Care Med 1994; 22: 1351–1358.PubMedGoogle Scholar
  7. 7.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23: 1638–1652.PubMedGoogle Scholar
  8. 8.
    Vincent JL, Moreno R, Takala J, et al. The sepsis-related organ failure assessment (SOFA) score to describe organ dysfunction/failure. Intensive Care Med 1996; 22: 707–710.PubMedGoogle Scholar
  9. 9.
    Bernard GR, Doig G, Hudson G, et al. Quantification of organ dysfunction for clinical trials in sepsis. Am Rev Respir Crit Care Med 1995; 151: A323.Google Scholar
  10. 10.
    Le Gall JR, Klar J, Lemeshow S, et al. The logistic organ dysfunction system-a new way to assess organ dysfunction in the intensive care unit. JAMA 1996; 276: 802–810.PubMedGoogle Scholar
  11. 11.
    Curling TB. On acute ulceration of the duodenum in cases of burns. Med Chir Trans Lond 1842; 25: 260–267.Google Scholar
  12. 12.
    Bywaters EGL. Anatomical changes in the liver after trauma. Clin Sci 1946; 6: 19–28.PubMedGoogle Scholar
  13. 13.
    Bywaters EGL, Beall O. Crush injuries with impairment of renal function. Br Med J 1941; 1: 427–438.PubMedGoogle Scholar
  14. 14.
    Safar P, DeKornfeld T, Pearson J, et al. Intensive care unit. Anesthesia 1961; 16: 275–281.Google Scholar
  15. 15.
    Burke JF, Pontoppidan H, Welch CE. High output respiratory failure: an important cause of death ascribed to peritonitis or ileus. Ann Surg 1963; 158: 581–595.PubMedGoogle Scholar
  16. 16.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967; 2: 319–323.PubMedGoogle Scholar
  17. 17.
    McCabe WR, Jackson GG: Gram negative bacteremia. Etiology and ecology. Arch Intern Med 1962; 110: 83–91.Google Scholar
  18. 18.
    Maclean LD, Mulligan WG, Mclean APH, Duff JH. Patterns of septic shock in man-a detailed study of 56 patients. Ann Surg 1967; 166: 543–562.PubMedGoogle Scholar
  19. 19.
    Skillman JJ, Bushnell LS, Goldman H, Silen W. Respiratory failure, hypotension, sepsis, and jaundice. A clinical syndrome associated with lethal hemorrhage and acute stress ulceration in the stomach. Am J Surg 1969; 117: 523–530.PubMedGoogle Scholar
  20. 20.
    Tilney NL, Bailey GL, Morgan AP. Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg 1973; 178: 117–122.PubMedGoogle Scholar
  21. 21.
    Baue AE. Multiple, progressive, or sequential systems failure. A syndrome of the 1970s. Arch Surg 1975; 110: 779–781.Google Scholar
  22. 22.
    Eiseman B, Beart R, Norton L. Multiple organ failure. Surg Gynecol Obstet 1977; 144: 323–326.PubMedGoogle Scholar
  23. 23.
    Fry DE, Pearlstein L, Fulton RL, Polk HC. Multiple system organ failure. The role of uncontrolled infection. Arch Surg 1980; 115: 136–140.PubMedGoogle Scholar
  24. 24.
    Polk HC, Shields CL. Remote organ failure: a valid sign of occult intraabdominal infection. Surgery (St. Louis) 1977; 81: 310–313.Google Scholar
  25. 25.
    Bell RC, Coalson JJ, Smith JD, Johanson WG. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 1983; 99: 293–298.PubMedGoogle Scholar
  26. 26.
    Deitch EA. Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 1992; 216: 117–134.PubMedGoogle Scholar
  27. 27.
    Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990’s. Systemic inflammatory response and organ dysfunction. JAMA 1994; 271: 226–233.PubMedGoogle Scholar
  28. 28.
    Jones HJS, de Cossart L. Rick scoring in surgical patients. Br J Surg 1999; 86: 149–157.PubMedGoogle Scholar
  29. 29.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993; 270: 2478–2486.PubMedGoogle Scholar
  30. 30.
    Hanley J, McNeil B. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.PubMedGoogle Scholar
  31. 31.
    Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115: 92–106.PubMedGoogle Scholar
  32. 32.
    Guyatt GH, Meade MO. Outcome measures: methodologic principles. Sepsis 1997; 1: 21–25.Google Scholar
  33. 33.
    Marshall JC. Multiple organ dysfunction syndrome (MODS). In: Sibbald WJ, Vincent J-L, eds. Clinical Trials for the Treatment of Sepsis. Berlin: Springer-Verlag, 1995: 122–138.Google Scholar
  34. 34.
    Schuster DP. Predicting outcome after ICU admission: the art and science of assessing risk. Chest 1992; 102: 1861–1870.PubMedGoogle Scholar
  35. 35.
    Ruttimann UE. Statistical approaches to development and validation of predictive instruments. Crit Care Clin 1994; 10: 19–35.PubMedGoogle Scholar
  36. 36.
    Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE, acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981; 9: 591–597.PubMedGoogle Scholar
  37. 37.
    Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality and critically ill hospitalized adults. Chest 1991; 100: 1619–1636.PubMedGoogle Scholar
  38. 38.
    Le Gall JR, Loirat P, Alperovitch A, et al. A simplified acute physiology score for ICU patients. Crit Care Med 1984; 12: 975977.Google Scholar
  39. 39.
    Le Gall J-R, Lemeshow S, et al., Intensive Care Unit Scoring Group. Customized probability models for early severe sepsis in adult intensive care patients. JAMA 1995; 273: 644–650.PubMedGoogle Scholar
  40. 40.
    Lemmonier E, Loirat P, et al., French Study Group on ARF. Translation ambiguity and inter-observer variability of severity scoring systems. Intensive Care Med 1992; 20: 581–587.Google Scholar
  41. 41.
    Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA. Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the acute physiology and chronic health evaluation III study. Crit Care Med 1993; 21: 1459–1465.PubMedGoogle Scholar
  42. 42.
    Damiano AM, Bergner M, Draper EA, Knaus WA, Wagner DP. Reliability of a measure of severity of illness: acute physiology of chronic health evaluation-II. J Clin Epidemiol 1992; 45: 93–101.PubMedGoogle Scholar
  43. 43.
    Bosman RJ, Oudemane van Straaten HM, Zandstra DF. The use of intensive care information systems alters outcome prediction. Intensive Care Med 1998; 24: 953–958.PubMedGoogle Scholar
  44. 44.
    Goldhill DR, Withington PS. Mortality predicted by APACHE II. The effect of changes in physiological values and post-ICU hospital mortality. Anaesthesia 1996; 51: 719–723.PubMedGoogle Scholar
  45. 45.
    Rowan K. The reliability of case mix measurement in intensive care. Curr Opin Crit Care 1996; 2: 209–213.Google Scholar
  46. 46.
    Dragsted L, Jorgensen J, Jensen NH, et al. Interhospital comparisons of patient outcome from intensive care: importance of lead-time bias. Crit Care Med 1989; 17: 418–422.PubMedGoogle Scholar
  47. 47.
    Escarce JJ, Kelley MA. Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. JAMA 1990; 264: 2389–2394.PubMedGoogle Scholar
  48. 48.
    Goldhill DR, Withington PS. The effect of casemix adjustment on mortality as predicted by APACHE II. Intensive Care Med 1996; 22: 415–419.PubMedGoogle Scholar
  49. 49.
    Osier TM, Rogers FB, Glance LG, Cohen M, Rutledge R, Shack-ford SR. Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS. J Trauma 1999; 45: 234–238.Google Scholar
  50. 50.
    Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients. Arch Surg 1990; 125: 519–522.PubMedGoogle Scholar
  51. 51.
    Murphy-Filkins R, Teres D, Lemeshow S, Hosmer DW. Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model: how to distinguish a general from a specialty intensive care unit. Crit Care Med 1996; 24: 1968–1973.PubMedGoogle Scholar
  52. 52.
    Lemeshow S, Le Gall JR. Modeling the severity of illness of ICU patients. A systems update. JAMA 1994; 272: 1049–1055.PubMedGoogle Scholar
  53. 53.
    Castella X, Artigas A, Bion J, Kari A, EuroNo American Severity Study Group. A comparison of severity of illness scoring systems for intensive care unit patients: Results of a multicenter, multinational study. Crit Care Med 1995; 23: 1327–1335.PubMedGoogle Scholar
  54. 54.
    Reina A, Vazquez G, Aguayo E, Bravo I, Colmenero M, Bravo M. Mortality discrimination in acute myocardial infarction: comparison between APACHE III and SAPS II prognosis systems. Intensive Care Mcd 1997; 23: 326–330.Google Scholar
  55. 55.
    Beck DH, Taylor BL, Millar B, Smith GB. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 1997; 25: 9–15.PubMedGoogle Scholar
  56. 56.
    Zimmerman JE, Wagner DP, Draper EA, Wright L, Alzola C, Knaus WA. Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database. Crit Care Med 1998; 26: 1317–1326.PubMedGoogle Scholar
  57. 57.
    Bertolini G, D’Amico R, Apolone G, et al. Predicting outcome in the intensive care unit using scoring systems: is new better? A comparison of SAPS and SAPS II in a cohort of 1393 patients. Med Care 1998; 36: 1371–1382.PubMedGoogle Scholar
  58. 58.
    Marks RJ, Simons RS, Blizzard RA, Browne DR. Predicting outcome in intensive therapy units-a comparison of APACHE II with subjective assessments. Intensive Care Med 1991; 17: 159163.Google Scholar
  59. 59.
    Teres D, Lemeshow S. Why severity models should be used with caution. Crit Care Clin 1994; 19: 93–110.Google Scholar
  60. 60.
    Lemeshow S, Klar J, Teres D. Outcome prediction for individual intensive care patients: useful, misused, or abused? Intensive Care Med 1995; 21: 770–776.PubMedGoogle Scholar
  61. 61.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986; 104: 410–418.PubMedGoogle Scholar
  62. 62.
    Multz AS, Chalfin DB, Samson IM, et al. A “closed” medical intensive care unit (MICU) improves resource utilization when compared with an “open” MICU. Am J Respir Crit Care Med 1998; 157: 1468–1473.PubMedGoogle Scholar
  63. 63.
    Sprung CL, Geber D, Eidelman LA, et al. Evaluation of triage decisions for intensive care admission. Crit Care Med 1999; 27: 1073–1079.PubMedGoogle Scholar
  64. 64.
    Randolph AG, Guyatt GH, Cadet J, for the Evidence Based Medicine in Critical Care Group. Understanding articles comparing outcomes among intensive care units to rate quality of care. Crit Care Med 1998; 26: 773–781.PubMedGoogle Scholar
  65. 65.
    Boyd O, Grounds RM. Physiological scoring systems and audit. Lancet 1993; 341: 1573–1574.PubMedGoogle Scholar
  66. 66.
    Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP. Intensive Care Society’s APACHE II study in Britain and Ireland. I: Variations in case mix of adult admissions to general intensive care units and impact on outcome. Br Med J 1993; 307: 972–977.Google Scholar
  67. 67.
    Teres D, Pekow P. A night in Tunisia. Crit Care Med 1998; 26: 812–813.PubMedGoogle Scholar
  68. 68.
    Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 1995; 23: 1177–1183.PubMedGoogle Scholar
  69. 69.
    Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP. Intensive Care Society’s APACHE II study in Britain and Ireland. II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. Br Med J 1993; 307: 977–981.Google Scholar
  70. 70.
    Sirio CA, Tajimi DT, Tase C. An initial comparison of intensive care in Japan and the United States. Crit Care Med 1992; 20: 1207–1215.PubMedGoogle Scholar
  71. 71.
    Bastos PG, Sun X, Wagner DP, Knaus WA, Zimmerman JE. Application of the APACHE III prognostic system in Brazilian intensive care units: a prospective multicenter study. Intensive Care Med 1996; 22: 564–570.PubMedGoogle Scholar
  72. 72.
    Nouira S, Belghith M, Elatrous S, et al. Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units. Crit Care Med 1998; 26: 852–859.PubMedGoogle Scholar
  73. 73.
    Rapoport J, Teres D, Barnett R, et al. A comparison of intensive care unit utilization in Alberta and western Massachusetts. Crit Care Med 1995; 23: 1336–1346.PubMedGoogle Scholar
  74. 74.
    Mackenzie TA, Greenaway-Coates A, Djurfeldt MS, Hopman WM. Use of severity of illness to evaluate quality of care. Int J Qual Health Care 1996; 8: 125–130.PubMedGoogle Scholar
  75. 75.
    Teres D, Lemeshow S. Using severity measures to describe high performance intensive care units. Crit Care Clin 1993; 9: 543–554.PubMedGoogle Scholar
  76. 76.
    Teres D, Higgins T, Steingrub J. Defining a high-performance ICU system for the 21st century: a position paper. J Intensive Care Med 1998; 13: 195–205.Google Scholar
  77. 77.
    Fisher CJ, Dhainaut J-FA, et al., Phase III rhIL-ira Sepsis Syndrome Study Group. Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. JAMA 1994; 271: 1836–1843.PubMedGoogle Scholar
  78. 78.
    Opal SM, Fisher CJ Jr, et al., IL-ira Sepsis Syndrome Study Group. Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial. Crit Care Med 1997; 25: 1115–1124.PubMedGoogle Scholar
  79. 79.
    Glance LG, Osier T, Shinozaki T. Intensive care unit prognostic scoring systems to predict death: a cost-effectiveness analysis. Crit Care Med 1998; 26: 1849.Google Scholar
  80. 80.
    Halevy A. Severity of illness scales and medical futility. Curr Opin Crit Care 1999; 5: 173–175.Google Scholar
  81. 81.
    Girou E, Pinsard M, Auriant I, Canone M. Influence of severity of illness measured by the implified Acute Physiology Score (SAPS) on occurrence of nosocomial infections in ICU patients. J Hosp Infect 1996; 34: 131–137.PubMedGoogle Scholar
  82. 82.
    Chang RWS, Jacobs S, Lec B. Predicting outcome among intensive care unit patients using computerised trend analysis of daily APACHE II scores corrected for organ system failure. Intensive Care Med 1988 44: 558–566.Google Scholar
  83. 83.
    Rogers J, Fuller HD. Use of daily Acute Physiology and Chronic Health Evaluation (APACHE) II scores to predict individual patient survival rate. Crit Care Med 1994; 22: 1402–1405.PubMedGoogle Scholar
  84. 84.
    Wagner DP, Knaus WA, Harrell FE, Zimmerman JE, Watts C. Daily prognostic estimates for critically ill adults in intensive care units: results from a prospective, multicenter, inception cohort analysis. Crit Care Med 1994; 22: 1359–1372.PubMedGoogle Scholar
  85. 85.
    Marshall JC, Bernard G, Le Gall J-R, Vincent J-L. The measurement of organ dysfunction/failure as an ICU outcome. Sepsis 1997; 1; 41–57.Google Scholar
  86. 86.
    Hebert PC, Drummond AJ, Singer J, Bernard GR, Russell JA. A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 1993; 104: 230–235.PubMedGoogle Scholar
  87. 87.
    Goris RJA, to Boekhorst TPA, Nuytinck JKS, Gimbrere JSF. Multiple organ failure. Generalized autodestructive inflammation? Arch Surg 1985; 120: 1109–1115.PubMedGoogle Scholar
  88. 88.
    Keene AR, Cullen DJ. Therapeutic intervention scoring system: update 1983. Crit Care Med 1983; 1 1: 1–3.Google Scholar
  89. 89.
    Cullen DJ, Ferrara LC, Briggs BA, Walker PF, Gilbert J. Survival, hospitalization charges and follow up results in critically ill patients. N Engl J Med 1976; 294: 982–987.PubMedGoogle Scholar
  90. 90.
    Dickie H, Vedio A, Dundas R, Treacher DF, Leach RM. Relationship between TISS and ICU costs. Intensive Care Med 1998; 24: 1009–1017.PubMedGoogle Scholar
  91. 91.
    Marshall JC. Charting the course of critical illness: prognostication and outcome description in the intensive care unit. Crit Care Med 1999; 27: 676–678.PubMedGoogle Scholar
  92. 92.
    Cook DJ, Guyatt GH, et al., Canadian Critical Care Trials Group. A randomized trial of sucralfate versus ranitidine for stress ulcer prophylaxis in critically ill patients. N Engl J Med 1998; 338: 791–797.PubMedGoogle Scholar
  93. 93.
    Barie PS, Hydo LJ, Fischer E. Utility of illness severity scoring for prediction of prolonged surgical critical care. J Trauma 1996; 40: 513–519.PubMedGoogle Scholar
  94. 94.
    Bane PS, Hydo LJ. Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization. Arch Surg 1996; 131: 1318–1324.Google Scholar
  95. 95.
    Vincent JL, De Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med 1998; 26: 1793–1800.PubMedGoogle Scholar
  96. 96.
    Staubach KH, Schröder J, Stüber F, Gehrke K, Traumann E, Zabel P. Effect of pentoxifylline in severe sepsis. Results of a randomized, double-blind, placebo-controlled study. Arch Surg 1998; 133: 94–100.PubMedGoogle Scholar
  97. 97.
    Marshall JC, Foster DM, et al., Toronto Hospital ICU Research Group. Quantification of the multiple organ dysfunction syndrome (MODS) as a risk factor, outcome descriptor, and surrogate measure of morbidity in the ICU. Crit Care Med 1996; 26 (suppl): A59.Google Scholar
  98. 98.
    Jacobs S, Zuleika M, Mphansa T. The multiple organ dysfunction score as a descriptor of patient outcome in septic shock compared with two other scoring systems. Crit Care Med 1999; 27: 741–744.PubMedGoogle Scholar
  99. 99.
    Meduri GU, Headley AS, Golden E, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998; 280: 159–165.PubMedGoogle Scholar
  100. 100.
    Hebert PC, Wells G, et al., Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group. A multicentre randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340: 409–417.PubMedGoogle Scholar
  101. 101.
    Faist E, Baue AE, Dittmer H, Heberer G. Multiple organ failure in polytrauma patients. J Trauma 1983; 23: 775–786.PubMedGoogle Scholar
  102. 102.
    Moore FA, Moore EE, Poggetti R, et al., Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma. J Trauma 1991; 31: 629–638.PubMedGoogle Scholar
  103. 103.
    Dybowski R, Weller P, Chang R, Gant V. Prediction of outcome in critically ill patients using artificial neural network synthesized by genetic algorithm. Lancet 1996; 347: 1146–1150.PubMedGoogle Scholar

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  • John C. Marshall

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