Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)

Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5 +/- 17.0 vs. 60.6 +/- 17.4 years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p = 0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35-0.59), p < 0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis

Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome.

Introduction: Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome.Methods: Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score.Results: A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, P < 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors.Conclusions: Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis. © 2012 Sakr et al.; licensee BioMed Central Ltd. -------------------------------------------------------------------------------

Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome

Introduction: Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome.Methods: Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score.Results: A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, P < 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors.Conclusions: Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis. \ua9 2012 Sakr et al.; licensee BioMed Central Ltd. -------------------------------------------------------------------------------

Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study

OBJECTIVE: To assess the incidence and severity of nonneurological organ dysfunction and its effect on outcome in acute neurological patients in an international cohort observational study. DESIGN AND SETTING: Analysis of database from the observational Sepsis Occurrence in Acutely Ill Patients (SOAP) study in 198 intensive care units (ICUs) in 24 European countries. PATIENTS: All adult patients admitted to the participating ICUs between 1 and 15 May 2002. Of the 3,147 patients in the SOAP database 373 (12%) were admitted with a neurological diagnosis, including 154 (41%) with traumatic brain injury and 186 (50%) with cerebrovascular accident. MEASUREMENTS AND RESULTS: Patients were followed until death, hospital discharge, or for 60 days. Neurological patients were younger and had a higher incidence of trauma and fewer comorbidities than nonneurological patients. Neurological patients developed ICU-acquired sepsis and respiratory failure more frequently than the other patients. ICU and hospital mortality rates were higher and ICU length of stay longer in neurological than in nonneurological patients. Multivariate logistic analysis showed that, in addition to the Glasgow Coma Score (GCS) and the presence of nontraumatic brain injury, cardiovascular failure, hepatic failure, and ALI/ARDS were the only factors independently associated with a higher risk of death in the ICU in patients with a neurological diagnosis. CONCLUSIONS: Although neurological patients were younger and had fewer comorbidities, they developed ICU-acquired sepsis and respiratory failure more frequently than other patients. Efforts should be oriented to reduce cardiovascular, hepatic, and respiratory complications

True changes in patient characteristics and outcomes or partially a reflection of different study populations? Discussion on “Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)”

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Comparison of dopamine and norepinephrine in the treatment of shock.

Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.Comparative StudyJournal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)

Contains fulltext : 190107.pdf (publisher's version ) (Open Access

Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)

Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5 ± 17.0 vs. 60.6 ± 17.4 years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p = 0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35–0.59), p < 0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis. © 2018, The Author(s)