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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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


Hypoxia or hypercarbia necessitating assisted ventilation for 3-5 days

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


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

Jaundice with bilirubin 8-10 mg/dL


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



Intolerance of gastric feeding for more than 5 days

Stress ulceration with need for transfusion, acalculous cholecystitis


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



Decreased ejection fraction with persistent capillary leak

Hyperdynamic state not responsive to pressors




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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