The multiple organ dysfunction syndrome is defined as the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention. The Multiple System Organ Failure Scoring system assesses seven key organ systems for failure on the first day of the sepsis syndrome. From the number of severely affected organs it is possible to predict the mortality of patients with the Sepsis Syndrome.

Diagnostic Criteria for Sepsis Syndrome


Patient must have a suspected or known site of infection.

Patient must have all 3 of the following:

(1) a core temperature > 101 °F (38.3°C) or < 96°F (35.5°C)

(2) a heart rate of 90 beats per minute in the absence of beta blockers

(3) respiratory rate of > 20 breaths per minute, or a minute ventilation > 10 L/min

Patient must have at least 1 of the following:

(1) cardiovascular system: hypotension <= 90 mm Hgor a fall in systolic blood pressure > 40 mm Hg for more than 1 hour, with filling pressures adequate or the patient unresponsive to at least 500 mL of saline solution infused over 1 hour

(2) renal system: urine output <= 0.5 mL/kg/hr for at least 1 hour

(3) pulmonary system: PaO2 <= 70 mm Hg on room air, or a PaO2/FIO2 ratio <= 333. If the primary diagnosis is pneumonia and if the lung is the only one of these 4 systems to fail, then the patient must meet established ARDS criteria: (a) PaO2/FIO2 < 200; (b) diffuse bilateral infiltrates on chest X-ray; (c) pulmonary artery wedge pressure < 19 mm Hg.

(4) central nervous system: significant alteration in mental status, with at least a decrease of 2 points in the Glasgow Coma Score


Multiple Organ Failure Scoring System


Organ System

Finding on the 1st day of sepsis syndrome


ventilation dependent with an A-a gradient of > 250 mm Hg, or a pulmonary shunt > 20%


adrenergic agents required to maintain the mean arterial pressure above 55 mm Hg in the absence of hypovolemia (pulmonary artery wedge pressure > 6 mm Hg)


creatinine > 300 µmol/L (3.4 mg/dL)


bilirubin > 60 µmol/L (3.4 mg/dL), or alkaline phosphatase > 350 U/L


fresh blood from nasogastric tube,or melena or fresh blood per rectum,and a fall of hemoglobin of at least 2 g/dL and requiring transfusion of at least 2 units of packed red cells in 24 hours


WBC < 2000/µL or platelet count < 40,000 /µL or evidence of DIC (INR > 2 plus PTT more than 2 times normal control plus fibrin degradation products > 10 mg/L)

Central nervous system

Glasgow coma score < 10, or a decrease in GCS of 3 or more if primary CNS injury is present



• conversion factor for creatinine µmol/L to mg/dL is 0.011312

• conversion factor for bilirubin µmol/L to mg/dL is 0.05848



• minimum score 0

• maximum score 7



Estimated Mortality


< 10%








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