Oddo et al identified prognostic factors for patients in the medical intensive care unit (MICU). These can help to identify a patient who may benefit from more aggressive management. The authors are from Columbia University in New York City.
Patient selection: adult in the MICU without known acute neurologic injury
Poor outcome included severe disability at hospital discharge, vegetative state or death.
Parameters evaluated by multivariate analysis:
(1) findings on a continuous electroencephalogram (EEG)
(2) age in years
(3) coma
(4) circulatory shock
(5) acute renal failure
(6) acute hepatic failure
|
Parameter |
Finding |
Adjusted Odds Ratio |
|
findings on continuous EEG |
normal |
1 |
|
|
seizures or periodic epileptiform discharges |
19 |
|
age of the patient |
<= 65 years |
1 |
|
|
> 65 years |
3 |
|
coma |
absent |
1 |
|
|
present |
2 |
|
circulatory shock |
absent |
1 |
|
|
present |
6 |
|
acute renal failure |
absent |
1 |
|
|
present |
3 |
|
acute hepatic failure |
absent |
1 |
|
|
present |
7 |
where:
• The presence of changes on continuous EEG are associated with sepsis.
• Most of the items represent an organ failure.
• The assumption is that each of the parameters is independent.
• I am not sure how the odds ratio for EEG changes is 19 when the authors say that about 90% of patients with changes had a poor outcome vs 40% if absent.
cumulative odds ratio for a poor outcome =
= PRODUCT(all 6 adjusted odd ratios)
Specialty: Critical Care, Emergency Medicine, Neurology
