What criteria are used to stage 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

Lung disease progresses to meet ARDS criteria. Encephalopathy or mild coagulopathy may accompany pulmonary dysfunction, which persists for 2-3 weeks. At this time, the patient either begins to recover or progresses to fulminant dysfunction in another organ system. Once another major organ dysfunction occurs (see Table 1 below), these patients frequently do not survive.

Table. Criteria for Organ Dysfunction (Open Table in a new window)

Organ System

Mild Criteria

Severe Criteria

Pulmonary

Hypoxia or hypercarbia necessitating assisted ventilation for 3-5 days

ARDS requiring PEEP >10 cm H2 O and FI O2< 0.5

Hepatic

Bilirubin 2-3 mg/dL or other liver function tests >2 × normal, PT elevated to 2 × normal

Jaundice with bilirubin 8-10 mg/dL

Renal

Oliguria (< 500 mL/day) or increasing creatinine (2-3 mg/dL)

Dialysis

Gastrointestinal

Intolerance of gastric feeding for more than 5 days

Stress ulceration with need for transfusion, acalculous cholecystitis

Hematologic

aPTT >125% of normal, platelets < 50-80,000

DIC

Cardiovascular

Decreased ejection fraction with persistent capillary leak

Hyperdynamic state not responsive to pressors

CNS

Confusion

Coma

Peripheral nervous system

Mild sensory neuropathy

Combined motor and sensory deficit

aPTT = activated partial thromboplastin time; ARDS = acute respiratory distress syndrome; CNS = central nervous system; DIC = disseminated intravascular coagulation; FI O2 = fraction of inspired oxygen; PEEP = positive end-expiratory pressure; PT = prothrombin time.


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