Clinical Research On Multiple Organ Failure In The Elderly

ObjectiveScientific basis can be provided for early clinical diagnosis,treatment,secondaryprevention and tertiary prevention by the study of clinical characteristic,survival timeand risk factors of MOFE(Multiple organ failure in the elderly).Object&Methods1.ObjectPatients and control groups are selected from inpatients and outpatients fromveteran cadres wards of Tongliao geriatric hospital during September1998to August2008who met MOFE diagnostic criteria.2.MethodsReferred to diagnostic criteria of MOFE and design requirements of case controlstudy,we have adopted the method of1:3matched case control study and follow-upresearch.The survey follow-up study was to investigate the general situation (age,gender), the basis of the disease (the number,category and severity), clinicalmanifestations (symptoms, signs, laboratory tests and examinations, etc.), the time ofsequential organ failure,the order of sequential organ failure, the survival time ofpatients and risk factors (incentives, disease state).3.Statistical analysisAll data were statistically analyzed using SAS9.13. Quantitative data wereexpressed as mean and standard deviation,the qualitative data were described with therates and their95%confidence intervals described; t test was used in balancing testquantitative data,x2test was used in qualitative data, and when the p-value was closeto0.05we used the Fisher exact test. Data analyses stage organ failure used Wilcoxon test. Case-control OR value and its95%confidence intervals were calculated usingunivariate and multivariate conditional Logistic regression analysis. Calculation ofsurvival rate and production of survival curves were done by using the product-limitmethod. Survival time was calculated by quartile method, the RR values and their95%confidence intervals of geriatric multiple organ failure and death risk factors andchronic underlying diseases were calculated using Cox regression analysis. All reportedP values are two-sided.Resultswe collected153MOFE patients for follow-up investigation in the experiment,found that113people died while40survived. The survival rate of MOFE was26.14%,the mortality rate of73.69%.Meanwhile in accordance with the inclusion criteria of thecontrol group,459people were randomly selected as a control group. The study foundthat the MOFE patients had at least two organs failing and involved eight failing organsat most, deaths cases had an average of4.25failing organs while survival casesinvolving an average of three failing organs; survival cases of failing organs wassignificantly less than the number of failing organs of the deaths cases (P〈0.000);theclinical stage of MOFE patients’failing organs have a significant difference constituentratio(P〈0.000).MOFE sequential organ failure interval is mostly less than10days(66.01%),generally not more than one month(19.61%).The MOFE’first failing organmostly seen in lungs (38.96%), heart (19.48%), central nervous system (14.94%),kidney (10.39%), gastrointestinal tract (8.44%).The MOFE patients with50%survival time was243days (69-601days). Thedifferent first failing organs own a short to long survival time:26days of the lungs,central nervous system42days,623days of the heart, kidneys1106days.Two kinds or more chronic underlying disease are there with MOFE patientsbefore the attack generally,3-6kinds of chronic diseases accounted for about76.47%;the most suffering from11kinds of underlying disease (0.65%);prone diseases:coronary heart disease (69.93%), hypertension (55.56%), multiple cerebral infarction(49.02%), chronic bronchitis (37.25%), elderly pneumonia (33.99%), diabetes (type1 and2)(24.84%), arteriosclerosis nephropathy (22.88%).Univariate analysis showed that: poor nutritional status, immune dysfunction,mental disorders, intestinal nutrient intake disorders, environment and climate of rapidchange, single or multiple organ dysfunction, infection, low T3syndrome, electrolyteimbalance, acid-base imbalance, hypoproteinemia, or low blood sugar, chronic anemia,arrhythmias, myocardial ischemic attack, hemorrhagic stroke, ischemic stroke, surgeryor trauma, mental shock, etc.18risk factors in exposure rate between the two groupsMOFE The difference was statistically significant (P <0.023~0.000), showed that thepresence of these risk factors, patients are more vulnerable to MOFE. The poornutritional status, immune function, intestinal nutrient intake disorders, environmentand climate of rapid change, electrolyte imbalance, hypoalbuminemia or low bloodsugar, chronic anemia, myocardial ischemia, seizures and other eight risk factorsexposure rate in MOFE death group and survival differences between the groups arestatistically significant (P <0.04~0.000). Showed that the presence of these risk factors,patients are more vulnerable to MOFE patients died.To further investigate the occurrence and risk factors MOFE (incentive) the degreeof association, while controlling for confounding factors, the first condition Logisticunivariate regression analysis, statistically significant factors univariate and thenmultivariate analysis, the results eventually enter the multivariate conditional Logisticregression model variables are: immune function, intestinal nutrient intake disorders,infections, electrolyte imbalance. The OR and95%CI,:5.26(2.10-13.19),8.09(2.73-23.96),9.33(3.43-25.37),28.75(5.58~148.11).To investigate the occurrence and risk factors MOFE (disease state) the degree ofassociation, while controlling for confounding factors, the first condition Logiticunivariate regression analysis, univariate statistically significant factors, and thenmultivariate conditional Logitic regression analysis, the results eventually enter modelvariables are: poor nutritional status, mental disorders, chronic anemia, arrhythmias,myocardial ischemic attack, hemorrhagic stroke, surgery or trauma, mental shock. TheOR and95%C1as follows:3.48(1.73-6.97),4.57(1.84-11.27),12.16(4.70~31.48),2.80(1.41to5.55),2.45(1.29to4.74),7.17(1.20to43.00),3.75(1.37to10.26),3.95 (1.08to14.54),7.84(1.71-36.00).ConclusionsMOFE patients always have two or more underlying disease before the onset,maximum11diseases, some kind of incentives to stimulate the occurrence, multipleorgan sequential failure is characterized by a short period of time, it can affect up to8failing organs, the first failing organ distribution who share the top four is the lung, theheart,the central nervous system and the renal. The multiple sequential order pulmonaryrank first, heart and kidney rank second, three.50%of patients with an average survivalof243days after the onset.Lungs and central nervous system as the first failingorgan,led the shortest survival time.We Found that poor nutritional status,immunedysfunction,mental disorders, intestinal nutrient intake disorders,infections,electrolyteimbalance,chronic anemia, arrhythmias, myocardial ischemic attack,hemorrhagicstroke,surgery or trauma,mental shock and other12factors are MOFE independent riskfactor for morbidity.