Tran et al developed a scoring system for multiple organ failure developing in patients receiving intensive care.
Organ systems - 7 evaluated:
(1) cardiovascular
(2) pulmonary
(3) renal
(4) hepatic
(5) hematologic
(6) gastrointestinal
(7) neurologic
Organ System |
Finding |
Score |
---|---|---|
cardiovascular |
• mean arterial pressure > 70 mm Hg • heart rate > 70 beats per minute |
0 |
|
• mean arterial pressure 51-70 mm Hg • heart rate 51 - 70 beats per minute • ventricular tachycardia |
1 |
|
• mean arterial pressure <= 50 mm Hg • heart rate <= 50 beats per minute • need for inotropic agents • ventricular fibrillation • cardiac arrest • acute myocardial infarction |
2 |
pulmonary |
• PEEP <= 4 cm H2O • FIO2 <= 0.3 • respiratory rate 12-24 per minute |
0 |
|
• PEEP 5 - 9 cm H2O • FIO2 > 0.3 and <= 0.4 • respiratory rate 6-11 per minute, or 25-49 per minute |
1 |
|
• PEEP >= 10 cm H2O • FIO2 > 0.4 • respiratory rate <= 5 per minute or >= 50 per minute |
2 |
renal |
serum creatinine <= 2.0 mg/dL |
0 |
|
serum creatinine > 2.0 and <= 3.5 mg/dL |
1 |
|
• serum creatinine > 3.5 mg/dL • chronic renal insufficiency • acute renal replacement therapy |
2 |
hepatic |
• bilirubin <= 2.0 mg/dL • AST <= 25 U/L |
0 |
|
• bilirubin > 2.0 and <= 3.0 mg/dL • AST > 25 and <= 50 U/L |
1 |
|
• bilirubin > 3.0 mg/dL • AST > 50 U/L • hepatic encephalopathy |
2 |
hematologic |
• hematocrit >= 30% • WBC count >= 3,000 per µL • platelet count > 100,000 per µL |
0 |
|
• hematocrit 21-29% • WBC count 290 - 3,000 per µL • platelet count 51,000 - 100,000 per µL |
1 |
|
• hematocrit <= 20% • WBC count < 300 per µL • platelet count <= 50,000 per µL • DIC |
2 |
gastrointestinal |
normal functioning |
0 |
|
• acalculous cholecystitis; • stress ulcer not requiring blood transfusion |
1 |
|
• bleeding from stress ulcer requiring > 2 units of blood in 24 hours; • necrotizing colitis; • necrotizing pancreatitis; • perforation of viscus or gallbladder |
2 |
neurologic |
Glasgow coma score 13-15 |
0 |
|
Glasgow coma score 7-12 |
1 |
|
Glasgow coma score <= 6 |
2 |
(Table I, page 22)
where:
• mean arterial pressure = ((2 * (diastolic pressure)) + (systolic pressure)) / 3
• "acute renal replacement therapy" I infer to mean dialysis
• The WBC count entry in original tables says that a score of 2 is assigned if the WBC <= 3,000 per µL, which overlaps with the assignment for a score of 1.
MOSF score =
= SUM(score for all 7 organ systems)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the MOSF score, the higher the mortality rate.
According to Figure 4, page 28:
estimated mortality in percent =
= (8.18 * (MOSF score)) - 18.86
Purpose: To use the Multiple Organ System Failure (MOSF) score to assess a patient requiring intensive care.
Specialty: Critical Care, Emergency Medicine
Objective: severity, prognosis, stage
ICD-10: R68.8,