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The Multiple Organ Dysfunction score as a descriptor of patient outcome in septic shock compared with two other scoring systems

Jacobs, Sydney MB, ChB, FRCA; Zuleika, Mehrun MB, ChB, FFARCSI; Mphansa, Thomas MB, ChB, FRCA

Clinical Investigations
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Objective To demonstrate if daily Multiple Organ Dysfunction scoring could describe outcome groups in septic shock better than daily Acute Physiology and Chronic Health Evaluation (APACHE) II and Organ Failure scores.

Design A prospective cohort study.

Setting A medical and surgical adult intensive care unit (ICU) at a tertiary referral center.

Measurements and Main Results Daily data collection over a 14-month period was performed on 368 ICU patients, 39 of whom developed septic shock while in the ICU. These data were entered into a computer programmed to calculate APACHE II, Organ Failure, and Multiple Organ Dysfunction scores. The admission Multiple Organ Dysfunction scores for nonsurvivors and survivors of septic shock in the ICU was 6.5 +/- 2.7 and 6.6 +/- 2.8 (SD), respectively. These patients deteriorated due to the development of septic shock during their ICU stay resulting in a maximum Multiple Organ Dysfunction score of 12.2 +/- 3.7 in nonsurvivors and 9.4 +/- 2.7 in survivors (p < .05). The difference between the maximum and initial Multiple Organ Dysfunction scores (delta score) was also significantly greater in nonsurvivors than in survivors (5.6 +/- 4.7 vs. 2.8 +/- 3.0) (p < .05). There were no significant differences between the maximum and delta scores in the outcome groups using the APACHE II and Organ Failure scoring systems. These results were mirrored by 2.3 +/- 0.7 and 1.7 +/- 0.5 organ failures in nonsurvivors and survivors, respectively (p < .01). For all 368 patients, the initial and maximum Multiple Organ Dysfunction scores were 3.5 +/- 2.5 and 10.5 +/- 3.6, respectively.

Conclusion Maximum and delta Multiple Organ Dysfunction scores mirrored organ dysfunction and could accurately describe the outcome groups, whereas daily APACHE II and Organ Failure scores could not. (Crit Care Med 1999;27:741-744)

From the Department of Intensive Care and Anaesthesia, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia.

Address requests for reprints to: Dr. Sydney Jacobs, Department of Intensive Care and Anaesthesia, Riyadh Armed Forces Hospital, PO Box 7897 Riyadh 11159, Kingdom of Saudi Arabia.

© 1999 Lippincott Williams & Wilkins, Inc.