Multiple System Organ Failure Score

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

Respiratory

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

Cardiovascular

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)

Renal

creatinine > 300 µmol/L (3.4 mg/dL)

Hepatic

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

Gastrointestinal

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

Hematologic

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

0

< 10%

1-2

25%

3-4

60-70%

>=5

100%