Multiple System Organ Failure

Prognosis for recovery from multiple organ system failure: the accuracy of objective estimates of chances for survival. The French Multicentric Group of ICU Research

This study evaluated the accuracy and reliability of predictions for recovery from multiple organ system failure (OSF). A previous analysis had provided estimates of the probabilities of recovery from various combinations of OSF for 2,843 intensive care unit (ICU) patients treated in 13 U.S. hospitals. These estimates were applied prospectively to 2,405 ICU admissions in 27 French hospitals. Despite variations in the incidences of underlying disease and the distributions of OSF between the two countries, clinical outcomes were similar for the 5,248 total patients. In both countries, two OSFs persisting for more than one day resulted in a hospital death rate of 60%. Hospital mortality rates for patients with three or more OSFs persisting after one day consistently exceeded 90%. Isolated neurologic failure had the poorest overall prognosis, but various other combinations of OSFs did not result in significantly different outcomes. The stability of the prognostic estimates in the two countries suggests that, despite pathogenetic variations, persistent multiple OSF results in consistent clinical outcomes. These mortality projections provide firm reference data for assessing efficacy of new treatments within institutions with similar standards of care. The narrow confidence intervals associated with these estimates also provide objectively defined opportunities to review future treatment plans for individual patients.