Early noncardiovascular organ failure and mortality in the cardiac intensive care unit.

Published on Jan 30, 2020in Clinical Cardiology2.882
路 DOI :10.1002/CLC.23339
Jacob C. Jentzer25
Estimated H-index: 25
(Mayo Clinic),
Brandon M. Wiley14
Estimated H-index: 14
(Mayo Clinic)
+ 5 AuthorsGregory W. Barsness41
Estimated H-index: 41
(Mayo Clinic)
Sources
Abstract
BACKGROUND: Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population. HYPOTHESIS: We hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients. METHODS: Adult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore >/=3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities. RESULTS: We included 10 004 patients with a mean age of 67 +/- 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5-3.7, P < .001). After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1-2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long-term mortality risk. CONCLUSIONS: Early noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues after hospital discharge, emphasizing the need to promote early recognition of organ failure in CICU patients.
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Background Prior studies have demonstrated that the cardiac intensive care unit (CICU) patient population has evolved over time. We sought to describe the temporal changes in comorbidities, illness severity, diagnoses, procedures and adjusted mortality within our CICU practice in recent years. Methods We retrospectively reviewed unique CICU admissions at the Mayo Clinic from January 2007 to April 2018. Comorbidities, severity of illness scores, discharge diagnosis codes and CICU procedures and t...
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#2Courtney Bennett (Mayo Clinic)H-Index: 13
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PURPOSE: To determine the impact of Sequential Organ Failure Assessment (SOFA) organ sub-scores for hospital mortality risk stratification in a contemporary cardiac intensive care unit (CICU) population. MATERIALS AND METHODS: Adult CICU admissions between January 1, 2007 and December 31, 2015 were reviewed. The SOFA score and organ sub-scores were calculated on CICU day 1; patients with missing SOFA sub-score data were excluded. Discrimination for hospital mortality was assessed using area unde...
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#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
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#1Courtney Bennett (Mayo Clinic)H-Index: 13
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#1Jacob C. Jentzer (Mayo Clinic)H-Index: 25
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Background Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU. Methods and Results Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute P...
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#1Eric M Holland (University of Virginia Health System)H-Index: 4
#2Travis J. Moss (University of Virginia Health System)H-Index: 10
Abstract Background Fifty years after the inception of the cardiac intensive care unit (CICU), noncardiovascular illnesses have become more prevalent and may contribute to morbidity and mortality. Objectives The authors performed multivariate statistical analyses to determine the association of acute noncardiovascular illnesses with outcomes, including length of stay (LOS), mortality, and hospital readmission. Methods We studied 1,042 admissions between October 12, 2013 and November 28, 2014 to ...
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#1Manu Shankar-Hari (Guy's and St Thomas' NHS Foundation Trust)H-Index: 36
#2David A HarrisonH-Index: 62
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Sepsis generates significant global acute illness burden. The international variations in sepsis epidemiology (illness burden) have implications for region specific health policy. We hypothesised that there have been changes over time in the sepsis definitional elements (infection and organ dysfunction), and these may have impacted on hospital mortality. Cohort study. We evaluated a high quality, nationally representative, clinical ICU database including data from 181 adult ICUs in England. Nine...
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