Table 1.
Organ dysfunction categories with corresponding ICD-9-CM codes and objective clinical markers
| Organ dysfunction | ICD-9-CM codesa | Objective clinical marker |
|---|---|---|
| Shock | 785.5 (Shock) | Any vasopressor or inotropeb during hospitalization |
| Respiratory | 518.81 (Acute respiratory failure) | Mechanical ventilation for ≥2 consecutive daysc |
| 518.82 (Other pulmonary insufficiency) | ||
| 799.1 (Respiratory arrest) | ||
| Renal | 584 (Acute kidney failure) | Peak creatinine ≥2.0 mg/dL and ≥1.5× increase from baselined |
| Acidosis | 276.2 (Acidosis) | Nadir pH <7.15e |
| Hepatic | 570 (Acute and subacute necrosis of liver) | Peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) during hospitalization >1000 units/L, or total bilirubin ≥6.0 mg/dL |
| 573.3 (Hepatitis unspecified) | ||
| 573.4 (Hepatic infarction) | ||
| Thrombocytopenia | 287.3 (Thrombocytopenia) | Nadir platelet count during hospitalization <50,000/μL and >50 % decrease from baselinef |
| 287.5 (Thrombocytopenia unspecified) | ||
| Coagulopathy | 286.6 (Defibrination syndrome) | Nadir fibrinogen during hospitalization <200 mg/dL or peak international normalized ratio (INR) >3.0 and increase by >0.5 from baselineg |
| 286.9 (Other and unspecified coagulation defects) |
ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
aWhere three- or four-digit codes are listed, all associated subcodes were included
bVasopressor = parenteral order for norepinephrine, dopamine, epinephrine, phenylephrine, or vasopressin. Inotrope = parenteral order for dobutamine or milrinone
cMechanical ventilation required for 2 or more consecutive calendar days, unless death occurs while on mechanical ventilation prior to the 2nd day
dBaseline value for creatinine defined as lowest value from 30 days prior to hospital admission through hospital discharge. Excludes patients with end-stage renal disease code (585.6)
eNadir pH could be from arterial or venous blood gas
fBaseline value for platelets defined as highest value from 30 days prior to hospital admission through hospital discharge
gBaseline value for INR defined as lowest value from 30 days prior to hospital admission through hospital discharge. Excludes any patient with order for warfarin from day 30 from hospitalization admission to hospital discharge