Prevalence of organ failure and mortality among patients in the emergency department: A population-based cohort study

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Objectives The aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival. Design This was a population-based cohort study of all citizens in four municipalities (population of 230 000 adults). Setting Emergency department at Odense University Hospital, Denmark. Participants We included all adult patients who arrived from 1 April 2012 to 31 March 2015. Primary and secondary outcome measures Organ failure was defined as a modified Sequential Organ Failure Assessment score≥2 within six possible organ systems: cerebral, circulatory, renal, respiratory, hepatic and coagulation. The primary outcome was prevalence of organ failure, and secondary outcomes were 0-7 days, 8-30 days and 31-365 days all-cause mortality. Results We identified in total 175 278 contacts, of which 70 399 contacts were further evaluated for organ failure. Fifty-two per cent of these were women, median age 62 (IQR 42-77) years. The incidence of new organ failure was 1342/100 000 person-years, corresponding to 5.2% of all emergency department contacts. The 0-7-day, 8-30-day and 31-365-day mortality was 11.0% (95% CI: 10.2% to 11.8%), 5.6% (95% CI: 5.1% to 6.2%) and 13.2% (95% CI: 12.3% to 14.1%), respectively, if the patient had one or more new organ failures at first contact in the observation period, compared with 1.4% (95% CI: 1.3% to 1.6%), 1.2% (95% CI: 1.1% to 1.3%) and 5.2% (95% CI: 5.0% to 5.4%) for patients without. Seven-day mortality ranged from hepatic failure, 6.5% (95% CI: 4.9% to 8.6%), to cerebral failure, 33.8% (95% CI: 31.0% to 36.8%), the 8-30-day mortality ranged from cerebral failure, 3.9% (95% CI: 2.8% to 5.3%), to hepatic failure, 8.6% (95% CI: 6.6% to 10.8%) and 31-365-day mortality ranged from cerebral failure, 9.3% (95% CI: 7.6% to 11.2%), to renal failure, 18.2% (95% CI: 15.5% to 21.1%). Conclusions The study revealed an incidence of new organ failure at 1342/100 000 person-years and a prevalence of 5.2% of all emergency department contacts. One-year all-cause mortality was 29.8% among organ failure patients.

OriginalsprogEngelsk
Artikelnummere032692
TidsskriftBMJ Open
Vol/bind9
Udgave nummer10
Antal sider9
ISSN2044-6055
DOI
StatusUdgivet - 1. okt. 2019

Fingeraftryk

Hospital Emergency Service
Cohort Studies
Population
Liver Failure
Incidence
Denmark
Observation
Outcome Assessment (Health Care)
Kidney
Liver

Citer dette

@article{cbcc210c5fde4d8bbbc6c8df06759eb8,
title = "Prevalence of organ failure and mortality among patients in the emergency department: A population-based cohort study",
abstract = "Objectives The aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival. Design This was a population-based cohort study of all citizens in four municipalities (population of 230 000 adults). Setting Emergency department at Odense University Hospital, Denmark. Participants We included all adult patients who arrived from 1 April 2012 to 31 March 2015. Primary and secondary outcome measures Organ failure was defined as a modified Sequential Organ Failure Assessment score≥2 within six possible organ systems: cerebral, circulatory, renal, respiratory, hepatic and coagulation. The primary outcome was prevalence of organ failure, and secondary outcomes were 0-7 days, 8-30 days and 31-365 days all-cause mortality. Results We identified in total 175 278 contacts, of which 70 399 contacts were further evaluated for organ failure. Fifty-two per cent of these were women, median age 62 (IQR 42-77) years. The incidence of new organ failure was 1342/100 000 person-years, corresponding to 5.2{\%} of all emergency department contacts. The 0-7-day, 8-30-day and 31-365-day mortality was 11.0{\%} (95{\%} CI: 10.2{\%} to 11.8{\%}), 5.6{\%} (95{\%} CI: 5.1{\%} to 6.2{\%}) and 13.2{\%} (95{\%} CI: 12.3{\%} to 14.1{\%}), respectively, if the patient had one or more new organ failures at first contact in the observation period, compared with 1.4{\%} (95{\%} CI: 1.3{\%} to 1.6{\%}), 1.2{\%} (95{\%} CI: 1.1{\%} to 1.3{\%}) and 5.2{\%} (95{\%} CI: 5.0{\%} to 5.4{\%}) for patients without. Seven-day mortality ranged from hepatic failure, 6.5{\%} (95{\%} CI: 4.9{\%} to 8.6{\%}), to cerebral failure, 33.8{\%} (95{\%} CI: 31.0{\%} to 36.8{\%}), the 8-30-day mortality ranged from cerebral failure, 3.9{\%} (95{\%} CI: 2.8{\%} to 5.3{\%}), to hepatic failure, 8.6{\%} (95{\%} CI: 6.6{\%} to 10.8{\%}) and 31-365-day mortality ranged from cerebral failure, 9.3{\%} (95{\%} CI: 7.6{\%} to 11.2{\%}), to renal failure, 18.2{\%} (95{\%} CI: 15.5{\%} to 21.1{\%}). Conclusions The study revealed an incidence of new organ failure at 1342/100 000 person-years and a prevalence of 5.2{\%} of all emergency department contacts. One-year all-cause mortality was 29.8{\%} among organ failure patients.",
keywords = "acute medicine, emergency department, mortality, organ failure, prevalence, risk stratification",
author = "Pedersen, {Peter Bank} and Henriksen, {Daniel Pilsgaard} and Mikkel Brabrand and Lassen, {Annmarie Touborg}",
year = "2019",
month = "10",
day = "1",
doi = "10.1136/bmjopen-2019-032692",
language = "English",
volume = "9",
journal = "B M J Open",
issn = "2044-6055",
publisher = "BMJ Group",
number = "10",

}

TY - JOUR

T1 - Prevalence of organ failure and mortality among patients in the emergency department

T2 - A population-based cohort study

AU - Pedersen, Peter Bank

AU - Henriksen, Daniel Pilsgaard

AU - Brabrand, Mikkel

AU - Lassen, Annmarie Touborg

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Objectives The aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival. Design This was a population-based cohort study of all citizens in four municipalities (population of 230 000 adults). Setting Emergency department at Odense University Hospital, Denmark. Participants We included all adult patients who arrived from 1 April 2012 to 31 March 2015. Primary and secondary outcome measures Organ failure was defined as a modified Sequential Organ Failure Assessment score≥2 within six possible organ systems: cerebral, circulatory, renal, respiratory, hepatic and coagulation. The primary outcome was prevalence of organ failure, and secondary outcomes were 0-7 days, 8-30 days and 31-365 days all-cause mortality. Results We identified in total 175 278 contacts, of which 70 399 contacts were further evaluated for organ failure. Fifty-two per cent of these were women, median age 62 (IQR 42-77) years. The incidence of new organ failure was 1342/100 000 person-years, corresponding to 5.2% of all emergency department contacts. The 0-7-day, 8-30-day and 31-365-day mortality was 11.0% (95% CI: 10.2% to 11.8%), 5.6% (95% CI: 5.1% to 6.2%) and 13.2% (95% CI: 12.3% to 14.1%), respectively, if the patient had one or more new organ failures at first contact in the observation period, compared with 1.4% (95% CI: 1.3% to 1.6%), 1.2% (95% CI: 1.1% to 1.3%) and 5.2% (95% CI: 5.0% to 5.4%) for patients without. Seven-day mortality ranged from hepatic failure, 6.5% (95% CI: 4.9% to 8.6%), to cerebral failure, 33.8% (95% CI: 31.0% to 36.8%), the 8-30-day mortality ranged from cerebral failure, 3.9% (95% CI: 2.8% to 5.3%), to hepatic failure, 8.6% (95% CI: 6.6% to 10.8%) and 31-365-day mortality ranged from cerebral failure, 9.3% (95% CI: 7.6% to 11.2%), to renal failure, 18.2% (95% CI: 15.5% to 21.1%). Conclusions The study revealed an incidence of new organ failure at 1342/100 000 person-years and a prevalence of 5.2% of all emergency department contacts. One-year all-cause mortality was 29.8% among organ failure patients.

AB - Objectives The aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival. Design This was a population-based cohort study of all citizens in four municipalities (population of 230 000 adults). Setting Emergency department at Odense University Hospital, Denmark. Participants We included all adult patients who arrived from 1 April 2012 to 31 March 2015. Primary and secondary outcome measures Organ failure was defined as a modified Sequential Organ Failure Assessment score≥2 within six possible organ systems: cerebral, circulatory, renal, respiratory, hepatic and coagulation. The primary outcome was prevalence of organ failure, and secondary outcomes were 0-7 days, 8-30 days and 31-365 days all-cause mortality. Results We identified in total 175 278 contacts, of which 70 399 contacts were further evaluated for organ failure. Fifty-two per cent of these were women, median age 62 (IQR 42-77) years. The incidence of new organ failure was 1342/100 000 person-years, corresponding to 5.2% of all emergency department contacts. The 0-7-day, 8-30-day and 31-365-day mortality was 11.0% (95% CI: 10.2% to 11.8%), 5.6% (95% CI: 5.1% to 6.2%) and 13.2% (95% CI: 12.3% to 14.1%), respectively, if the patient had one or more new organ failures at first contact in the observation period, compared with 1.4% (95% CI: 1.3% to 1.6%), 1.2% (95% CI: 1.1% to 1.3%) and 5.2% (95% CI: 5.0% to 5.4%) for patients without. Seven-day mortality ranged from hepatic failure, 6.5% (95% CI: 4.9% to 8.6%), to cerebral failure, 33.8% (95% CI: 31.0% to 36.8%), the 8-30-day mortality ranged from cerebral failure, 3.9% (95% CI: 2.8% to 5.3%), to hepatic failure, 8.6% (95% CI: 6.6% to 10.8%) and 31-365-day mortality ranged from cerebral failure, 9.3% (95% CI: 7.6% to 11.2%), to renal failure, 18.2% (95% CI: 15.5% to 21.1%). Conclusions The study revealed an incidence of new organ failure at 1342/100 000 person-years and a prevalence of 5.2% of all emergency department contacts. One-year all-cause mortality was 29.8% among organ failure patients.

KW - acute medicine

KW - emergency department

KW - mortality

KW - organ failure

KW - prevalence

KW - risk stratification

U2 - 10.1136/bmjopen-2019-032692

DO - 10.1136/bmjopen-2019-032692

M3 - Journal article

C2 - 31666275

AN - SCOPUS:85074294745

VL - 9

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 10

M1 - e032692

ER -