Physiologic Abnormalities and Outcome From Acute Disease: Evidence for a Predictable Relationship

doi:10.1001/archinte.1986.00360190171024

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Vol. 146 No. 7, July 1986

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Physiologic Abnormalities and Outcome From Acute Disease

Evidence for a Predictable Relationship

Douglas P. Wagner, PhD; William A. Knaus, MD; Elizabeth A. Draper, RN, MS

Arch Intern Med. 1986;146(7):1389-1396.

Abstract

• Initial physiologic data from 1625 nonoperative patientswith 18 acute life-threatening diseases treated in an intensivecare unit suggest a uniform predictable relationship betweenacute changes in normal physiologic balance and a patient'srisk of death. We found that Incremental deviations from normalphysiologic balance represent equivalent and predictable incrementalrisks to survival, regardless of the disease Initiating thephysiologic disturbance. The relative impact of these physiologicabnormalities on outcome may depend on our understanding ofthe disease's mechanism of action. Diseases for which thereis good understanding of underlying pathophysiology and precisetreatment appear to have lower death rates throughout the rangeof physiologic imbalance compared with those for which pathophysiologicknowledge is limited or unknown. These results document theimportance of pathophysiologic understanding to Improving survivalfrom acute disease. More importantly, they suggest a predictablerelationship between risk of death and physiologic abnormalitiesfor a wide range of diseases. The existence of such a relationshipcould greatly expand our prognostic ability and permit improvedevaluation of new therapeutic discoveries.

(Arch Intern Med 1986;146:1389-1396)

Author Affiliations

From the Departments of Anesthesiology and Computer Medicine, and the Intensive Care Research Unit, George Washington University Medical Center, Washington, DC.

Footnotes

Accepted for publication Sept 27, 1985.

Reprint requests to Director, Intensive Care Research Unit,2300 K St NW, Washington, DC 20037 (Dr Knaus).

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