• W H Hartl, H Wolf, C P Schneider, J Fertmann, H Küchenhoff, and K-W Jauch.
• Chirurgische Klinik und Poliklinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München. whartl@med.uni-muenchen.de
• Dtsch. Med. Wochenschr. 2006 Nov 3;131(44):2456-60.

BackgroundThe association of multiple organ failure and acute prognosis is an established fact in intensive care medicine. However, it is unclear whether the number of failing organs is an independent determinant of acute mortality, and whether there are additional effects on long-term outcome.MethodsWe performed a retrospective, observational cohort study using prospectively collected data from March 1993, through February 2005. Three different cohorts were analysed: patients with a short-term intensive care unit (ICU) stay (group I, ICU length of stay > 4 days), with a long-term ICU stay (group II, ICU length of stay > 28 days), and all patients requiring renal replacement therapy during ICU stay (group III). Organ failure was defined according to a modified Goris score. An independent effect of the number of failing organs on patient prognosis was evaluated after adjusting for more than 15 covariables. Acute prognosis was analysed in group I, whereas long-term prognosis was studied in groups II and III.ResultsThe maximum number of failing organs was an independent determinant of acute prognosis in patients of group I, and of long-term prognosis in groups II and III.ConclusionThe effect of multiple organ failure on long-term prognosis emphasizes the importance of this variable for patient outcome. Therefore, multiple organ failure must be part of all therapeutic concepts in critical care. Within those, preventive measures are definitively preferable to keep the number of failing organs as small as possible.

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