Dados do Trabalho

Título

Targeted Organ Dysfunction Assessment in ICU Patients: Unveiling Mortality Risks Beyond SOFA Scores

Objetivo

To evaluate the impact of organ dysfunctions on clinical outcomes in ICU patients.

Métodos

A cohort study was conducted on adult patients admitted to a private ICU in João Pessoa, Brazil, in 2023.

Resultados

Out of 2337 ICU admissions, 1256 (53.7%) were female, 1899 (81.3%) were medical cases, and 1775 (76%) were admitted from the Emergency Department. The median age was 71 years. Key scores included a Charlson Comorbidity Index (CCI) of 1, MFI score of 0.18, SAPS3 of 48, and serum lactate of 1.5 mmol/L. The overall mortality rate was 9.9%, with a median ICU stay of 3 days. The median SOFA score was 2, with patients showing neurological (39.6%), hemodynamic (17.3%), respiratory (45.8%), hematologic (17.9%), renal (23.7%), and hepatic (18.1%) dysfunctions. Patients who died had a higher incidence of hematologic (21.2% vs. 17.5%, p<0.001) and neurological (41.7% vs. 39.4%, p=0.028) dysfunctions, but lower rates of hepatic (15% vs. 18.5%, p<0.001), renal (23.8% vs. 22.9%, p=0.01), and respiratory (44.8% vs. 46%, p=0.210) dysfunctions. Hematologic (OR 1.473, p=0.03), neurological (OR 1.463, p=0.027), respiratory (OR 1.404, p=0.018), and renal (OR 1.485, p=0.002) dysfunctions were significant predictors of mortality. However, the total SOFA score (OR 0.877, p=0.062) and the number of organ dysfunctions (OR 1.166, p=0.296) were not consistent predictors.

Conclusão

Specific organ dysfunctions, particularly hematologic, neurological, respiratory, and renal, were stronger predictors of mortality than the total SOFA score or the number of organ dysfunctions. Focusing on these dysfunctions in ICU management may enhance patient outcomes.