What is the prognosis of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Mortality from MODS remains high. Mortality from ARDS alone is 40-50%; once additional organ system dysfunction occurs, mortality increases as much as 90%. Several clinical trials have demonstrated a mortality ranging from 40% to 75% in patients with MODS arising from sepsis.

The poor prognostic factors are advanced age, infection with a resistant organism, impaired host immune status, and poor prior functional status. Development of sequential organ failure despite adequate supportive measures and antimicrobial therapy is a harbinger of a poor outcome.

There is a graded severity from SIRS to sepsis, severe sepsis, and septic shock, with associated 28-day mortality rates of approximately 10%, 20%, 20-40%, and 40-60%, respectively. [15]

A multicenter prospective study published in the Journal of the American Medical Association reported a mortality of 56% during ICU stay. [16] Of all deaths, 27% occurred within 2 days of the onset of severe sepsis, and 77% of all deaths occurred within the first 14 days. The risk factors for early mortality in this study were a higher severity of illness score, the presence of 2 or more acute organ failures at the time of sepsis, shock, and a low blood pH (< 7.3).

Lobo et al determined that MODS is the primary cause of death in high-risk patients after surgery; the risk factors for death due to multiple organ failure should be considered in determining risk stratification. [17]


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