[Early goal-directed therapy lowers the incidence, severity and mortality of multiple organ dysfunction syndrome]

Abstract

Objective: To investigate the effect of early goal-directed therapy (EGDT) on the incidence, severity and mortality of multiple organ dysfunction syndrome (MODS).

Methods: A prospective, randomized controlled trial was performed involving 273 patients in the early stage of shock at risk of potential MODS development. The patients were randomly divided into EGDT group (including 139 patients managed with EGDT) and control group (including 134 patients with conventional empirical therapy). The scores of APACHE II, blood lactate concentration (Lactate(0)) and SOFA scores (SOFA(0)) of the two groups were recorded on admission, and the lactate concentration on the second and fourth day of hospitalization (Lactate(2) and Lactate(4)), and the highest SOFA scores (SOFAT) after admission were also recorded. The discrepancy between the two SOFA scores (SOFA(S)), number of the dysfunctional organ, and the mortality in ICU of the two groups were calculated at the end of the study.

Results: The incidence of MODS in the EGDT group was significantly lower than that in control group (P=0.002). The Lactate(2), Lactate(4), SOFA(T), SOFA(S), and the number of dysfunctional organs in EGDT group were also significantly lower (P=0.045, 0.016, 0.009, 0.010, 0.002). EGDT was associated with a significantly lower total mortality rate of MODS than the conventional therapy (P=0.007), and also with a significantly lower mortality rate of MODS after controlling for severe sepsis (P=0.047 and 0.044).

Conclusion: EGDT can decrease the incidence and severity of MODS, and can effectively decrease the mortality of MODS irrespective of the presence of severe sepsis.