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Published on: January 16, 2019
[Multi-center clinical study on the diagnostic criteria for multiple organ dysfunction syndrome with illness severity
Shu-Wen Zhang1, Chao Wang, Cheng-Hong Yin
1Department of Infection and Emergency, Beijing Friendship Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100050, China.
Objective:
To establish the diagnostic criteria for multiple organ dysfunction syndrome (MODS) with illness severity score according to the evaluation of clinical MODS data from hosptal in Beijing.
Methods:
The clinical data from 413 MODS cases in eight hospitals with III-leve in Beijing was analyzed by multi-center retrospective cohort study. The significant difference of the each descriptor between non-survivor group and survivor group was analyzed, and then the significant descriptor was selected as the potential indicator. Based on the above analysis, the abnormal range of each descriptor was divided into 4 intervals, assigned corresponding points, diagnostic criteria for MODS was established.
Results:
Severe infection, major operations, trauma and severe pancreatitis were the main etiological factor for MODS. The mortality of MODS in hospital was 53.5%, and the mortality rate for 28 days hospitalization was 37.3%. The correspondent mortality rate in MODS with 2-6 dysfunction organs was 28.6%-100.0%. The mortality rate of MODS complicated by the dysfunction of brain, cardiovascular system, kidney, and lung was 72.8%, 64.3%, 61.7%, and 54.7% respectively. The frequency of machinery ventilation support was 76.0% and the frequency of hemodialysis was 8.2%. The script of diagnostic criteria for MODS with the illness severity score system was established. The script mainly was involved in the evaluation of seven organs or systems, including respiratory system, cardiovascular system, kidney, hemologic system, liver and alimentary system. Only one parameter was used in each organ, they were FiO(2)/PaO(2), systolic blood pressure (SBP), serum creatinine, platelet count, conscious state and the defecation status. 0-4 scores were endued with each index according to the severity of the illnesses respectively. Every descriptor was 5 points, showing 0 point with normal organ function, and 1-4 scores with organ dysfunction and aggravation.
Conclusion:
The mortality of MODS in hospitals is 53.5% in Beijing. The main etiological factors for MODS still are severe infection, major operations, trauma and severe pancreatitis. The diagnostic criteria for MODS with the illness severity score and the prognostic evaluation system established might have clinical significance and practicability, but further studies with large samples are still needed.
