In Reply.—We appreciate the review and critique by Dr Sirio et al of our research relating the outcome assessment features of the APACHE II system in patients who develop multiple organ failure syndrome (MOFS).
Two of their major criticisms implicate selective bias and the impact of disease on the predictive outcome that we observed. An important observation is that the major cause of death in patients in surgical intensive care units (SICUs) is MOFS. We asked, therefore, if this large group of SICU patients who develop MOFS during the 7 to 10 days after SICU admission can be discriminated from other patients by their admission APACHE II scores or by the predictive equation. If one refers to Fig 1 of our article, the distribution of the APACHE II scores of our patient population was not different from that of patients admitted to the general SICU or from that