ABSTRACT
Multiorgan dysfunction syndrome represents a continuum of cumulative organ dysfunction from very mildly altered function to total and, rarely, irreversible organ failure and is the major cause of death in the intensive care unit (ICU). The terms multiple organ failure syndrome (MOFS), multiple organ system failure (MOSF), and multiple organ failure (MOF) have since been used to describe this syndrome. Infections were initially thought to be the main cause of multiorgan dysfunction; however, other insults, such as severe trauma, burn injuries, and noninfectious inflammatory diseases may precipitate a similar condition. In 2001, several North American and European intensive care societies revisited the definitions for sepsis and related conditions. Additional criteria indicative of physiological derangements were added to the traditional systemic inflammatory response syndrome (SIRS) criteria, including clinical abnormalities (altered mental status, ileus) and biochemical evidence of a sepsis response [procalcitonin (PCT), C-reactive protein (CRP), creatinine, or cytokine levels]. The use of organ failure scores to describe organ dysfunction in ICU patients was encouraged. The pulmonary, cardiovascular, renal, hepatic, hematologic, and central nervous systems are the organs most commonly considered when describing organ dysfunction/failure in the ICU. Scoring systems for organ dysfunction/failure were designed primarily as descriptive tools, aimed at establishing standardized definitions to stratify and compare patients in the ICU in terms of morbidity rather than mortality. Sequential evaluation of organ dysfunction during the ICU stay may track disease progression and may be useful prognostically. We discuss the various scoring systems developed over the past 2 decades and present a rational approach to their role in assessing and following critically ill patients.
KEYWORDS
Multiple organ failure syndrome (MOFS) - multiple organ failure (MOF) - multiple organ system failure (MOSF) - sepsis - prognostication
REFERENCES
-
1
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.
Crit Care Med.
1992;
20
(6)
864-874
-
2
Vincent J L, Moreno R, Takala J et al..
The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
Intensive Care Med.
1996;
22
(7)
707-710
-
3
Deitch E A.
Multiple organ failure: pathophysiology and potential future therapy.
Ann Surg.
1992;
216
(2)
117-134
-
4
de Mendonça A, Vincent J L, Suter P M et al..
Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score.
Intensive Care Med.
2000;
26
(7)
915-921
-
5
Vincent J L, Sakr Y, Sprung C L Sepsis Occurrence in Acutely Ill Patients Investigators et al.
Sepsis in European intensive care units: results of the SOAP study.
Crit Care Med.
2006;
34
(2)
344-353
-
6
Bertleff M J, Bruining H A.
How should multiple organ dysfunction syndrome be assessed? A review of the variations in current scoring systems.
Eur J Surg.
1997;
163
(6)
405-409
discussion-410
-
7
Levy M M, Fink M P, Marshall J C SCCM/ESICM/ACCP/ATS/SIS et al.
2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.
Crit Care Med.
2003;
31
(4)
1250-1256
-
8
Vincent J L, de Mendonça A, Cantraine F et al..
Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine.
Crit Care Med.
1998;
26
(11)
1793-1800
-
9
Fry D E, Pearlstein L, Fulton R L, Polk Jr H C.
Multiple system organ failure: the role of uncontrolled infection.
Arch Surg.
1980;
115
(2)
136-140
-
10
Stevens L E.
Gauging the severity of surgical sepsis.
Arch Surg.
1983;
118
(10)
1190-1192
-
11
Dewar D, Moore F A, Moore E E, Balogh Z.
Postinjury multiple organ failure.
Injury.
2009;
40
(9)
912-918
-
12
Bhatia M, Wong F L, Cao Y et al..
Pathophysiology of acute pancreatitis.
Pancreatology.
2005;
5
(2--3)
132-144
-
13
Kobayashi K, Ikeda H, Higuchi R et al..
Epidemiological and outcome characteristics of major burns in Tokyo.
Burns.
2005;
31
(Suppl 1)
S3-S11
-
14
Martin G S, Mannino D M, Eaton S, Moss M.
The epidemiology of sepsis in the United States from 1979 through 2000.
N Engl J Med.
2003;
348
(16)
1546-1554
-
15
Dulhunty J M, Lipman J, Finfer S. Sepsis Study Investigators for the ANZICS Clinical Trials Group .
Does severe non-infectious SIRS differ from severe sepsis? Results from a multi-centre Australian and New Zealand intensive care unit study.
Intensive Care Med.
2008;
34
(9)
1654-1661
-
16
Knaus W A, Zimmerman J E, Wagner D P, Draper E A, Lawrence D E.
APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.
Crit Care Med.
1981;
9
(8)
591-597
-
17
Le Gall J R, Lemeshow S, Saulnier F.
A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study.
JAMA.
1993;
270
(24)
2957-2963
-
18
Vosylius S, Sipylaite J, Ivaskevicius J.
Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis.
Croat Med J.
2004;
45
(6)
715-720
-
19
Peres Bota D, Melot C, Lopes Ferreira F, Nguyen Ba V, Vincent J L.
The multiple organ dysfunction score (MODS) versus the sequential organ failure assessment (SOFA) score in outcome prediction.
Intensive Care Med.
2002;
28
(11)
1619-1624
-
20
Cook R, Cook D, Tilley J, Lee K, Marshall J. Canadian Critical Care Trials Group .
Multiple organ dysfunction: baseline and serial component scores.
Crit Care Med.
2001;
29
(11)
2046-2050
-
21
Ferreira F L, Bota D P, Bross A, Mélot C, Vincent J L.
Serial evaluation of the SOFA score to predict outcome in critically ill patients.
JAMA.
2001;
286
(14)
1754-1758
-
22
Cabré L, Mancebo J, Solsona J F and the Bioethics Working Group of the SEMICYUC et al.
Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of sequential organ failure assessment scores in decision making.
Intensive Care Med.
2005;
31
(7)
927-933
-
23
Marshall J C, Cook D J, Christou N V, Bernard G R, Sprung C L, Sibbald W J.
Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.
Crit Care Med.
1995;
23
(10)
1638-1652
-
24
Le Gall J R, Klar J, Lemeshow S ICU Scoring Group et al.
The logistic organ dysfunction system: a new way to assess organ dysfunction in the intensive care unit.
JAMA.
1996;
276
(10)
802-810
-
25
Moreno R, Miranda D R, Matos R, Fevereiro T.
Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge.
Intensive Care Med.
2001;
27
(6)
999-1004
-
26
Fagon J Y, Chastre J, Novara A, Medioni P, Gibert C.
Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model.
Intensive Care Med.
1993;
19
(3)
137-144
-
27
Vincent J L, Angus D C, Artigas A Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group et al.
Effects of drotrecogin alfa (activated) on organ dysfunction in the PROWESS trial.
Crit Care Med.
2003;
31
(3)
834-840
-
28
Kajdacsy-Balla Amaral A C, Andrade F M, Moreno R, Artigas A, Cantraine F, Vincent J L.
Use of the sequential organ failure assessment score as a severity score.
Intensive Care Med.
2005;
31
(2)
243-249
-
29
Ho K M.
Combining sequential organ failure assessment (SOFA) score with acute physiology and chronic health evaluation (APACHE) II score to predict hospital mortality of critically ill patients.
Anaesth Intensive Care.
2007;
35
(4)
515-521
-
30
Rivera-Fernández R, Nap R, Vázquez-Mata G, Reis Miranda D.
Analysis of physiologic alterations in intensive care unit patients and their relationship with mortality.
J Crit Care.
2007;
22
(2)
120-128
-
31
Knaus W A, Draper E A, Wagner D P, Zimmerman J E.
Prognosis in acute organ-system failure.
Ann Surg.
1985;
202
(6)
685-693
-
32
Goris R J, te Boekhorst T P, Nuytinck J K, Gimbrère J S.
Multiple-organ failure: generalized autodestructive inflammation?.
Arch Surg.
1985;
120
(10)
1109-1115
-
33
Hebert P C, Drummond A J, Singer J, Bernard G R, Russell J A.
A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome.
Chest.
1993;
104
(1)
230-235
-
34
Pine R W, Wertz M J, Lennard E S, Dellinger E P, Carrico C J, Minshew B H.
Determinants of organ malfunction or death in patients with intra-abdominal sepsis: a discriminant analysis.
Arch Surg.
1983;
118
(2)
242-249
-
35
Moore F A, Sauaia A, Moore E E, Haenel J B, Burch J M, Lezotte D C.
Postinjury multiple organ failure: a bimodal phenomenon.
J Trauma.
1996;
40
(4)
501-510
discussion 510-512
-
36
Bernard G R.
Sepsis trials. Intersection of investigation, regulation, funding, and practice.
Am J Respir Crit Care Med.
1995;
152
(1)
4-10
-
37
Buckley T A, Gomersall C D, Ramsay S J.
Validation of the multiple organ dysfunction (MOD) score in critically ill medical and surgical patients.
Intensive Care Med.
2003;
29
(12)
2216-2222
-
38
Arts D G, de Keizer N F, Vroom M B, de Jonge E.
Reliability and accuracy of sequential organ failure assessment (SOFA) scoring.
Crit Care Med.
2005;
33
(9)
1988-1993
-
39
Ceriani R, Mazzoni M, Bortone F et al..
Application of the sequential organ failure assessment score to cardiac surgical patients.
Chest.
2003;
123
(4)
1229-1239
-
40
Tsai M H, Peng Y S, Lien J M et al..
Multiple organ system failure in critically ill cirrhotic patients: a comparison of two multiple organ dysfunction/failure scoring systems.
Digestion.
2004;
69
(3)
190-200
-
41
Janssens U, Graf C, Graf J et al..
Evaluation of the SOFA score: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders. Sequential organ failure assessment.
Intensive Care Med.
2000;
26
(8)
1037-1045
-
42
Hantke M, Holzer K, Thöne S, Schmandra T, Hanisch E.
The SOFA score in evaluating septic illnesses. Correlations with the MOD and APACHE II score [in German].
Chirurg.
2000;
71
(10)
1270-1276
-
43
Blanco J, Muriel-Bombín A, Sagredo V Grupo de Estudios y Análisis en Cuidados Intensivos et al.
Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study.
Crit Care.
2008;
12
(6)
R158
-
44
Timsit J F, Fosse J P, Troché G OUTCOMEREA Study Group, France et al.
Calibration and discrimination by daily logistic organ dysfunction scoring comparatively with daily sequential organ failure assessment scoring for predicting hospital mortality in critically ill patients.
Crit Care Med.
2002;
30
(9)
2003-2013
-
45
Doughty L A, Kaplan S S, Carcillo J A.
Inflammatory cytokine and nitric oxide responses in pediatric sepsis and organ failure.
Crit Care Med.
1996;
24
(7)
1137-1143
-
46
Leteurtre S, Martinot A, Duhamel A et al..
Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study.
Lancet.
2003;
362
(9379)
192-197
-
47 Sakr Y, Sponholz C, Reinhart K. Organ dysfunction in the ICU, a clinical perspective. In: Vincent J L, ed. 2007 Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer-Verlag; 2007: 238-245
-
48
Oda S, Hirasawa H, Sugai T et al..
Comparison of sepsis-related organ failure assessment (SOFA) score and CIS (cellular injury score) for scoring of severity for patients with multiple organ dysfunction syndrome (MODS).
Intensive Care Med.
2000;
26
(12)
1786-1793
-
49
Pettilä V, Pettilä M, Sarna S, Voutilainen P, Takkunen O.
Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill.
Crit Care Med.
2002;
30
(8)
1705-1711
-
50
Wang H, Ye L, Yu L et al..
Performance of sequential organ failure assessment, logistic organ dysfunction and multiple organ dysfunction score in severe sepsis within Chinese intensive care units.
Anaesth Intensive Care.
2011;
39
(1)
55-60
-
51
Zygun D A, Laupland K B, Fick G H, Sandham J D, Doig C J.
Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients.
Can J Anaesth.
2005;
52
(3)
302-308
-
52
Khwannimit B.
A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients.
J Med Assoc Thai.
2007;
90
(6)
1074-1081
-
53
Moreno R P, Metnitz B, Adler L, Hoechtl A, Bauer P, Metnitz P G. SAPS 3 Investigators .
Sepsis mortality prediction based on predisposition, infection and response.
Intensive Care Med.
2008;
34
(3)
496-504
-
54
Metnitz P G, Moreno R P, Almeida E SAPS 3 Investigators et al.
SAPS 3—from evaluation of the patient to evaluation of the intensive care unit,I: Objectives, methods and cohort description.
Intensive Care Med.
2005;
31
(10)
1336-1344
-
55
Rubulotta F, Marshall J C, Ramsay G, Nelson D, Levy M, Williams M.
Predisposition, insult/infection, response, and organ dysfunction: a new model for staging severe sepsis.
Crit Care Med.
2009;
37
(4)
1329-1335
-
56
Howell M D, Talmor D, Schuetz P, Hunziker S, Jones A E, Shapiro N I.
Proof of principle: the predisposition, infection, response, organ failure sepsis staging system.
Crit Care Med.
2011;
39
(2)
322-327
-
57
Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R.
PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia.
Crit Care Med.
2009;
37
(2)
456-462
-
58
Lisboa T, Diaz E, Sa-Borges M et al..
The ventilator-associated pneumonia PIRO score: a tool for predicting ICU mortality and health-care resources use in ventilator-associated pneumonia.
Chest.
2008;
134
(6)
1208-1216
Yasser SakrM.D. Ph.D.
Department of Anesthesiology and Intensive Care, Friedrich Schiller University Hospital, Erlanger Allee 101
07743 Jena, Germany
Email: yasser.sakr@med.uni-jena.de
