Multiple system organ failure in acute respiratory failure

To establish the frequency and prognostic value of multisystem organ failure (MSOF) in patients with acute respiratory failure (ARF) and to test the clinical impression that the death from respiratory failure alone is unusual, 225 patients with ARF admitted consecutively to our intensive care unit during a 3-year period were studied prospectively. All patients were treated with mechanical ventilation. The overall mortality was 35% (79 patients). Acute respiratory failure with one organ failure (OF) was diagnosed in 68 patients (30%; mortality rate, 15%); with two OFs in 40 patients (18%; mortality rate, 45%); with three OFs in 23 patients (10%; mortality rate, 91%), and with more than three OFs in 30 patients (13%; mortality rate, 100%). There were no deaths due to ARF without any other OF (64 patients, 28% of the total). Ninety-three patients had ARF plus MSOF (two or more OFs), and their mortality rate was 74% (P < .001). Sepsis was the most common clinical condition associated with the development of MSOF and was responsible for the high mortality in most of the patients. We conclude that MSOF is a major determinant of the prognosis and a good predictor of mortality in ARF of diverse causes.