Pattern of Presentation of Multiple Organ Dysfunction Syndrome in Critically ill Patients in a sub-Saharan Tertiary Centre.

Abstract

Background: Multiple organ dysfunction syndrome is the sequential failure of several organ systems after a trigger event, like sepsis, massive transfusions, burns, trauma and cardiogenic shock.
Aim and Objectives- The pattern of presentation of multiple organ dysfunction and the risk factors associated with multiple organ dysfunction in critically ill patients were evaluated.
Patients and Methods: Seventy-five patients admitted for more than 24 hours into the intensive care unit were prospectively studied. The occurrence of multiple organ dysfunction (MODs) was evaluated daily using individual organ system failure score (OSF). MODs was diagnosed when at least three organ systems were involved. Factors associated with the development of MODs were identified using a stepwise, multivariate, logistic regression analysis. A p value of <0.05 was considered significant for all tests.
Results: MODs occurred in 41 patients (54.67%). Mortality increased with the number of organ dysfunction. The observed incidence of dysfunction of 1, 2, 3, and > 4 organ systems were 20%, 26.7%, 33.3%, and 14.7% respectively with corresponding mortality rates of 53.3%, 70%, 92%, and 100%.Mortality was 56% in patients with MODs compared with 7.1% in the non-MODs group, (p <0.0001). MODs occurring within 72 hours exhibited a mortality rate of 56% compared with 18% in those manifesting MODs later (p = 0.026). The major determinants of the MODs in critically ill patients were haemodynamic instability, (OR = 5.57, 95% CI =1.16-26.84), Glasgow Coma scale < 8, (OR = 5.57, 95% CI = 1.25-24.92), SIRS, (OR = 1.74, 95% CI = 1.14-2.64), and increased creatinine level >308 μmol/L (OR = 1.41, 95% CI = 1.73- 11.39).
Conclusion: MODs is common in critically ill patients in our ICU and the mortality increased with increased number of organ dysfunction. The risk factors associated with MODs included haemodynamic instability, GCS d”8, SIRS and increased creatinine level >308 μmol/L.

Key Words: MODs, OSF, critically ill, mortality