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Does acute organ dysfunction predict patient-centered outcomes?

Clermont, G and Angus, DC and Linde-Zwirble, WT and Griffin, MF and Fine, MJ and Pinsky, MR (2002) Does acute organ dysfunction predict patient-centered outcomes? Chest, 121 (6). 1963 - 1971. ISSN 0012-3692

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Abstract

Background: Long-term patient-centered outcomes after acute illness may be associated with baseline health status, the development of acute organ dysfunction (AOD), or both. Study objective: To determine whether AOD (occurring in the first 30 days) was independently associated with 90-day survival, functional status, and health-related quality of life (HRQL) after controlling for baseline health status in patients who were hospitalized with community-acquired pneumonia (CAP) and survived to day 30. Design: Prospective observational study. Setting: Four hospitals in Pennsylvania, Massachusetts, and Nova Scotia, Canada, between October 1991 and March 1994. Patients: One thousand three hundred thirty-nine patients who were hospitalized with CAP. Interventions: Baseline and 90-day quality-of-life and functional status questionnaires. Measurements and results: We determined the 90-day survival rate in all patients (n = 1,339) and the functional status and HRQL in subsets of 261 and 219 patients, respectively. AOD occurred in one or more organ system in 639 patients (47.7%) and in two or more organ systems in 255 patients (19.1%). In univariate analyses, greater AOD was associated with a higher mortality rate (p < 0.0001), a lower HRQL (p = 0.006), and lower functional status (p = 0.009) at 90 days. However, after adjusting for baseline HRQL, AOD was not associated with mortality (p = 0.47) or HRQL (p = 0.14) at 90 days and was only weakly associated with 90-day functional status (p = 0.02). Conclusions: Although patients who develop AOD are at risk for late adverse outcomes, their risk is due predominantly to poor baseline status prior to illness and not to the organ dysfunction per se. Therefore, AOD does not appear to have significant long-term ramifications for patient-centered outcomes. © 2002 Elsevier Science Ltd. All rights reserved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Clermont, Gcler@pitt.eduCLER
Angus, DCangusdc@pitt.eduANGUSDC
Linde-Zwirble, WT
Griffin, MF
Fine, MJmjf1@pitt.eduMJF1
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 January 2002
Date Type: Publication
Journal or Publication Title: Chest
Volume: 121
Number: 6
Page Range: 1963 - 1971
DOI or Unique Handle: 10.1378/chest.121.6.1963
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0012-3692
PubMed ID: 12065364
Date Deposited: 20 Mar 2012 15:53
Last Modified: 02 Feb 2019 16:58
URI: http://d-scholarship.pitt.edu/id/eprint/11488

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