An Overview of Multiple Organ Dysfunction Syndrome

Multiple organ dysfunction syndrome (MODS) carries a serious risk of mortality.

In order to prevent it from progressing to an irreversible stage, immediate detection and treatment are crucial (Procter 2019).

What is Multiple Organ Dysfunction Syndrome?

Multiple organ dysfunction syndrome (MODS) is defined as the progressive physiological dysfunction of two or more organ systems where homeostasis cannot be maintained without intervention (Osterbur et al. 2014; Nickson 2019).

MODS is generally initiated by illness, injury or infection, causing a state of immunodepression and hypometabolism (Nickson 2019).

Rather than a single event, MODS is considered a continuum where the extent of dysfunction can vary greatly from mild impairment to irreversible failure (Al-Khafaji 2020).

Organs most commonly affected by MODS include the heart, lungs, liver and kidneys (Gu et al. 2018).

It is associated with significant mortality and morbidity, estimated to affect around 15% of ICU patients and contributing to about 50% of deaths in ICU (Nickson 2019; Osterbur et al. 2014).

Causes of Multiple Organ Dysfunction Syndrome

MODS is induced by illness, injury or infection that triggers an unregulated systemic inflammatory response (known as systemic inflammatory response syndrome), resulting in tissue injury (Harper & Saeb-Parsy 2013; Rossaint & Zarbock 2015).

The most common trigger is sepsis, but other causes include:

• Major trauma;
• Major surgery;
• Burns;
• Pancreatitis;
• Shock;
• Aspiration syndromes;
• Blood transfusions;
• Autoimmune disease;
• Acute heart failure; and
• Poisons/toxins.

(Nickson 2019; Wang et al. 2017; Harjola et al. 2017)

Risk Factors for Multiple Organ Dysfunction Syndrome

• An individual’s genetics may dictate the likelihood and severity of MODS following a trigger.
• A patient with premorbid organ dysfunction may be prone to further deterioration.
• Medications, therapies and ICU supports may contribute to organ injuries.
• A patient with an infection is at risk of MODS.

(Nickson 2019)

How to Assess for Multiple Organ Dysfunction Syndrome

• Undertake a systems approach assessment (head-to-toe assessment).
• Document and analyse data from the patient’s vital signs, taking into account any trends.
• A SOFA score can be used in line with other assessment tools.

(Nickson 2019)

Presentation and Symptoms of Multiple Organ Dysfunction Syndrome

In order to be diagnosed with MODS, the patient should be experiencing dysfunction of at least two organs (this may be mild or severe) in addition to systemic inflammatory response syndrome (Nickson 2019).

Organ dysfunction may present as:

• Acute kidney injury (AKI) and uraemic acidosis;
• Acute respiratory distress syndrome (ARDS);
• Cardiomyopathy;
• Encephalopathy;
• Gastrointestinal dysfunction;
• Hepatic dysfunction;
• Coagulopathy and bone marrow suppression; and
• Acute neurological dysfunction.

(Nickson 2019)

The patient may display some of the following symptoms depending on which organs are affected:

• An altered mental state;
• A decrease in renal perfusion (decrease in urine output);
• Respiratory deterioration;
• A decrease in cardiac function;
• Deranged metabolic status;
• A compromised fluid balance;
• Pale, clammy, peripherally cool skin and faint pedal pulses; and
• A decrease in cardiac output (e.g. low blood pressure, arrhythmia).

(Procter 2019; Rahman, Shad & Smith 2012)

Systemic inflammatory response syndrome may present as:

• Increased body temperature;
• Increased resting heart rate;
• Increased respiratory rate; and
• An increased amount of white blood cells.

(Washmuth 2017)

Treatment and Management of Multiple Organ Dysfunction Syndrome

MODS is difficult to treat, escalates quickly and is often fatal. Therefore, early detection is crucial in preventing its progression (Wang et al. 2017).

Positive patient outcomes rely on immediate recognition, ICU admission and invasive organ support (Gourd & Nikitas 2019). Management and treatment may include:

• Identifying and treating the underlying causes, comorbidities or complications;
• Fluid resuscitation to increase perfusion; and
• Support care and monitoring:
  • Multi-organ support;
  • Mechanical or non-invasive ventilation;
  • Maintaining fluid homeostasis; and
  • Renal replacement therapy.

(Nickson 2019; Chapalain 2019; Scala & Pisani 2018)

Preventing Multiple Organ Dysfunction Syndrome

As a complication of an illness, injury or infection, MODS is difficult to prevent. Early recognition improves patient outcomes - this is the only way to prevent damage.

It is important to monitor patients closely and administer appropriate therapies to facilitate organ function (Al-Khafaji 2020).

• Maintain an accurate fluid balance chart;
• Support the haemodynamic needs of the patient (identify low blood pressure, analyse trends, escalate to the medical team and treat early);
• Identify any potential triggers of MODS;
• Ensure regular blood tests are performed; and
• Decrease the risk of further organ damage if MODS is identified through early implementation of care.

Complications of Multiple Organ Dysfunction Syndrome

While MODS itself is the complication of an underlying condition, it represents a spectrum of dysfunction and can rapidly increase in severity (Wang et al. 2017).

In the later stages of MODS, the affected organs may completely lose function (multiple organ failure). This carries a mortality risk of up to 80 to 96% and may not be reversible. Preventing MODS from progressing into organ failure is therefore crucial (Wang et al. 2017).

If the patient becomes increasingly unwell, they may require intensive care admission and aggressive treatment to maximise organ function.

Conclusion

MODS is a serious condition and can be life-threatening if not addressed early. If a patient presents with MODS, escalate care as necessary and support the affected organs.

Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your facility's policy on preventing and responding to deterioration and multiple organ dysfunction syndrome.

Additional Resources

• Sepsis: Signs, Symptoms and qSOFA

References

• Al-Khafaji, A H 2020, ‘Multiple Organ Dysfunction Syndrome in Sepsis’, Medscape, viewed 20 May 2020, https://emedicine.medscape.com/article/169640-ovsystemirview
• Al-Khafaji, A H 2020, ‘Multiple Organ Dysfunction Syndrome in Sepsis Q&A’, Medscape, viewed 21 May 2020, https://emedicine.medscape.com/article/169640-questions-and-answers
• Chapalain et al. 2019, ‘Association Between Fluid Overload and SOFA Score Kinetics in Septic Shock Patients: a Retrospective Multicenter Study’, Journal of Intensive Care, vol. 7 no. 42, viewed 21 May 2020, https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-019-0394-0
• Gourd, N M & Nikitas, N 2019, ‘Multiple Organ Dysfunction Syndrome’, Journal of Intensive Care Medicine, viewed 20 May 2020, https://journals.sagepub.com/doi/abs/10.1177/0885066619871452
• Gu, C, Qiao, W, Wang, L, Li, M & Song, K 2018, ‘Identification of Genes and Pathways Associated With Multiple Organ Dysfunction Syndrome by Microarray Analysis’, Molecular Medicine Reports, vol. 18 no. 1, viewed 20 May 2020, https://www.spandidos-publications.com/10.3892/mmr.2018.8973
• Harjola, V et al. 2017, Organ Dysfunction, ‘Injury and Failure in Acute Heart Failure: From Pathophysiology to Diagnosis and Management. A Review on Behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)’, European Journal of Heart Failure, vol. 19 no. 7, viewed 20 May 2020, https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.872
• Harper, S J F & Saeb-Parsy, K 2013, Essential Surgery E-Book: Problems, Diagnosis and Management, Elsevier Health Sciences, viewed 20 May 2020, https://books.google.com.au/books?id=RYhRAAAAQBAJ&dq=mods+unregulated+immune+response&source=gbs_navlinks_s
• Nickson, C 2019, Multiple Organ Dysfunction Syndrome, Life in the Fastlane, viewed 20 May 2020, https://litfl.com/multiple-organ-dysfunction-syndrome/
• Osterbur, K, Mann, F A, Kuroki, K & DeClue, A 2014, ‘Multiple Organ Dysfunction Syndrome in Humans and Animals’, J Vet Intern Med, vol. 28 no. 4, viewed 20 May 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857933/
• Procter, L D 2019, ‘Shock’, MSD Manual, viewed 20 May 2020, https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/low-blood-pressure-and-shock/shock
• Rahman, Shad & Smith 2012, ‘Acute Kidney Injury: A Guide to Diagnosis and Management’, American Family Physician, vol. 86, no. 7, viewed 20 May 2020, https://www.aafp.org/afp/2012/1001/p631.html
• Rossaint, J & Zarbock, A 2015, ‘Pathogenesis of Multiple Organ Failure in Sepsis’, Crit Rev Immunol., vol. 35 no. 4, viewed 20 May 2020, https://pubmed.ncbi.nlm.nih.gov/26757392/
• Scala, R & Pisani, L 2018, ‘Noninvasive Ventilation in Acute Respiratory Failure: Which Recipe for Success?’, European Respiratory Review, vol. 27 no. 149, viewed 21 May 2020, https://err.ersjournals.com/content/27/149/180029
• Wang, Z et al. 2017, ‘Clinical Application of a Novel Diagnostic Scheme Including Pancreatic β‑cell Dysfunction for Traumatic Multiple Organ Dysfunction Syndrome’, Molecular Medicine Reports, vol. 17 no. 1, viewed 20 May 2020, https://www.spandidos-publications.com/10.3892/mmr.2017.7898
• Washmuth, D 2017, Multi-Organ Dysfunction Syndrome: Causes, Diagnosis & Management, Study.com, viewed 20 May 2020, https://study.com/academy/lesson/multi-organ-dysfunction-syndrome-causes-diagnosis-management.html