SEVERITY STRATIFICATION AND OUTCOME PREDICTION FOR MULTISYSTEM ORGAN FAILURE AND DYSFUNCTION

Multiple organ system failure or dysfunction (MOSF/MODS) remains a maj or cause of morbidity and mortality in hospitalized adults. Among inte nsive care unit (ICU) patients the extent of physiologic derangement, the type of associated disease or injury, increasing age, and life-thr eatening comorbid conditions are the major determinants of risk for de veloping MOSF and for survival during the 1980s. Hospital mortality fo r patients with a single organ system failure (OSF) lasting more than 1 day approached 40%; and for those with two OSFs hospital mortality i ncreased to 60%. These outcomes did not change over the decade. For pa tients with three or more OSFs persisting after 3 days of OSF, how-eve r, data suggest that between 1982 and 1990 the mortality has been redu ced from 98% to 84% (p = 0.0003). Because of variations in the types a nd combinations of OSFs, associated disease, and extent of physiologic derangement, it is difficult to interpret variations in mortality amo ng patients with one or more OSFs defined using categorical criteria. For this and other reasons, outcome prediction based on a comprehensiv e assessment of patient risk factors is a more sensitive, specific, us eful approach to quantifying MODS than a simple count of the number an d duration of OSFs. Because repeated assessment of risk factors during subsequent ICU days reflects complications and response to therapy, d aily outcome predictions are even more precise than estimates at ICU a dmission. The ability to more accurately predict survival from MODS/MO SF can improve our ability to Lest new therapies, evaluate how outcome has changed over time, and assess the efficacy of supportive therapy for individuals.