Clinical study of the impact of a history of chronic diseases on the mortality of patients with multiple organ dysfunction syndrome in the elderly

OBJECTIVE: To analyze the clinical feature of multiple organ dysfunction syndrome in the elderly (MODSE) and study the impact of a history of chronic diseases on the mortality of patients with MODSE. METHODS: Altogether 331 cases with MODSE were prospectively analyzed in 4 tertiary-level teaching hospitals in Beijing and Tianjin cities from March 2002 to January 2005. RESULTS: In our investigation,the primary etiology of MODSE was severe infection (27.2%), shock (24.5%), major operation (22.1%), cardiopulmonary resuscitation (CPR) (11.2%), severe trauma (7.2%), or severe pancreatitis (6.6%) in order of frequency. The incidence rate of dysfunction in cardiovascular system, lung, brain, gastrointestinal system, kidney, coagulation system and liver was 72.2%, 94.6%, 74.6%, 83.1%, 77.9%, 76.1%, 77.6% respectively. The mortality rates in the group with dysfunction of lung, brain, cardiovascular and gastrointestinal system were higher than those with the normal organ function. The mortality rate of patients with brain dysfunction ranked the highest (74.1%). Seventy-eight point five percent of patients with MODSE had a history of chronic diseases, and in average with two chronic diseases. The mortality rate of patients with chronic diseases was higher than those without chronic diseases (68.1% vs. 54.9%, P=0.039). With the increase in number of failing organs, mortality was getting higher. CONCLUSION: Infection is the most common primary cause, lung and gastrointestinal system are the most affected organs in multiple organ dysfunction, and the mortality rate of patients with brain dysfunction is the highest. The mortality rate of patients with chronic diseases is higher than those without chronic diseases. Early intervention of primary diseases and chronic diseases and prompt control of infection play a key role in preventing deterioration of patients with MODSE.