Does Acute Organ Dysfunction Predict Patient-Centered Outcomes?

• Published in: Chest Vol. 121; no. 6; pp. 1963 - 1971
• Main Authors: Clermont, Gilles, Angus, Derek C., Linde-Zwirble, Walter T., Griffin, Martin F., Fine, Michael J., Pinsky, Michael R.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.06.2002; American College of Chest Physicians; Elsevier B.V
• Subjects: Adolescent; Adult; Aged; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Causes of; community-acquired pneumonia; Complications and side effects; critical illness; Critically ill; Cross infection; Female; Health aspects; Hospitalization; Hospitals; Human bacterial diseases; Humans; Illnesses; Infectious diseases; Male; Medical sciences; Middle Aged; Mortality; Multiple organ failure; Multiple Organ Failure - mortality; Multiple Organ Failure - physiopathology; Multiple Organ Failure - rehabilitation; Nosocomial infections; organ dysfunction; organ failure; outcome; Patient-Centered Care; Patients; Pneumonia; Prognosis; Prospective Studies; Quality of Life; surrogate outcomes; Variance analysis; Canada; United States; United States > US; Nova Scotia Canada; Massachusetts; Pennsylvania; HRQL; critical illness; CI; community-acquired pneumonia; surrogate outcomes; organ dysfunction; SF-36; CAP; ANOVA; AOD; organ failure; mortality; quality of life; outcome; Human; Lung disease; Pneumonia; Prognosis; Respiratory disease; Acute; Mortality; Multiple organ failure; Morbidity; Incidence; Infection; Community acquired infection; Risk factor; Bacteriosis; Complication; Organ
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.121.6.1963

Long-term patient-centered outcomes after acute illness may be associated with baseline health status, the development of acute organ dysfunction (AOD), or both. To determine whether AOD (occurring in the first 30 days) was independently associated with 90-day survival, functional status, and health-related quality of life (HRQL) after controlling for baseline health status in patients who were hospitalized with community-acquired pneumonia (CAP) and survived to day 30. Prospective observational study. Four hospitals in Pennsylvania, Massachusetts, and Nova Scotia, Canada, between October 1991 and March 1994. One thousand three hundred thirty-nine patients who were hospitalized with CAP. Baseline and 90-day quality-of-life and functional status questionnaires. We determined the 90-day survival rate in all patients (n = 1,339) and the functional status and HRQL in subsets of 261 and 219 patients, respectively. AOD occurred in one or more organ system in 639 patients (47.7%) and in two or more organ systems in 255 patients (19.1%). In univariate analyses, greater AOD was associated with a higher mortality rate (p < 0.0001), a lower HRQL (p = 0.006), and lower functional status (p = 0.009) at 90 days. However, after adjusting for baseline HRQL, AOD was not associated with mortality (p = 0.47) or HRQL (p = 0.14) at 90 days and was only weakly associated with 90-day functional status (p = 0.02). Although patients who develop AOD are at risk for late adverse outcomes, their risk is due predominantly to poor baseline status prior to illness and not to the organ dysfunction per se. Therefore, AOD does not appear to have significant long-term ramifications for patient-centered outcomes.