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Does Acute Organ Dysfunction Predict Patient-Centered Outcomes?^*

^* From the Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory (Drs. Clermont and Angus), Department of Critical Care Medicine (Dr. Pinsky), and Department of Medicine (Dr. Fine), Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA; and Health Process Management, LLC (Mr. Linde-Zwirble and Mr. Griffin), Doylestown, PA.

Correspondence to: Derek C. Angus, MD, MPH, 604 Scaife Hall, University of Pittsburgh, Department of Anesthesiology/Critical Care Medicine, 200 Lothrop St, Pittsburgh, PA 15213; e-mail: angusdc{at}anes.upmc.edu

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.

Key Words: community-acquired pneumonia • critical illness • mortality • organ dysfunction • organ failure • outcome • quality of life • surrogate outcomes

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