Epidemiology and Characteristics of Organ Failure and Support in the Medical Intensive Care Units: A Prospective Cohort Study

Anupol Panitchote¹, Boonsong Patjanasoontorn¹, Anakapong Phunmanee¹, Veeradej Pisprasert², Sornwichate Rattanachaiwong², Ladda Inpromma³, Sidarut Samuksaman³, Phayom Bunsut³, Jiraporn Sriton³, Janjira Daungornnam³

Affiliation : ¹ Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, ² Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, ³ Medical Intensive Care Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Objective: The objectives are to explore the characteristics of organ failure and support in the medical intensive care units and exam the effect of organ failure on mortality.
Materials and Methods: This was a prospective cohort study of critically ill medical patients. All consecutive patients were collected for one year. Demographic data, organ failure characteristics, and support were recorded. Outcomes were mortality at day 28, 90, and year one.
Results: A total of 446 patients were included. The median age was 60 years (IQR 46, 73), and the male was 58.3%. Median Charlson comorbidities index was 4 points (IQR 2, 4). Median APACHE II and SOFA scores were 23 (IQR 18, 30) and 8 points (IQR 5, 11). Acute respiratory failure (ARF) developed 69.1% (95% CI 61.7 to 70.2). Mechanical ventilation duration was 6 days (95% CI 4 to 6), whereas the ventilator-free day on day 28 was 22 days (95% CI 16 to 23). Ventilator associated pneumonia rate was 9.4 events per 1,000 ventilator-days (95% CI 6.1 to 13.8). Acute kidney injury (AKI) developed 71.5% (95% CI 66.8 to 75.7): 25.2%, 20.5%, and 54.3% had stage I, II, III AKI. Patients developed shock 66.8%. Septic shock was the most common type. The median time to start nutrition support was 1 day (IQR 1.0, 2.0). Mortality at day 28, day 90, and 1 year were 30.7% (95% CI 26.6 to 35.1), 42.4% (95% CI 37.9 to 47), and 53.8% (95% CI 49.2 to 58.4). ARF had a constant effect on death at day 28 (HR 3.68, 95% CI 1.96 to 6.91). Shock had a peak effect on mortality since day 1 of ICU admission (HR 120.3, 95% CI 4.76 to 3,040.7) and still had a significant impact on day 28 (HR 2.07, 95% CI 1.14 to 3.74). Development of stage III AKI had an earlier effect than stage II AKI on mortality and a peak effect at day 28.
Conclusion: AKI and ARF were common in ICU. Shock had the highest effect on mortality, followed by ARF and AKI.

DOI:10.35755/jmedassocthai.2023.S01.13759

Keywords : Organ failure; Medical critically ill patients; Intensive care unit; Mortality; Epidemiology

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