Multiple Organ Dysfunction Syndrome (MODS): Is It Preventable or Inevitable?


Multiple organ dysfunction syndrome (MODS) is a systemic, dysfunctional inflammatory response that requires long intensive care unit (ICU) stay. It is characterized with high mortality rate depending on the number of organs involved. It has been recognized that organ failure does not occur as an all-or-none rule, but rather a range of organ dysfunction exists resulting in clinical organ failure. In the absence of a gold standard scoring or tool for early diagnosis or prediction of MODS, a novel bio-clinical scoring is mandatory. Moreover, understanding the pathophysiology of MODS in medical, surgical and trauma, ICUs should take a priority to achieve a favorable outcome. Herein we reviewed the literatures published in English language through the research engines (MEDLINE, Scopus, and EBASE) from 1982 to 2011 using key words: “multiorgan dysfunction”, “organ failure”, “intensive care units” to highlight the definition, mechanism, diagnosis and prediction of MODS particularly at its earliest stages. Bring up new bio-clinical scoring to a stage where it is ready for field trials will pave the way for implementing new risk-stratification strategy in the intensive care to reduce the morbidity and mortality and save resources. Prospective studies are needed to answer our question and to shift MODS from an inevitable to a preventable disorder.

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El-Menyar, A. , Thani, H. , Zakaria, E. , Zarour, A. , Tuma, M. , AbdulRahman, H. , Parchani, A. , Peralta, R. and Latifi, R. (2012) Multiple Organ Dysfunction Syndrome (MODS): Is It Preventable or Inevitable?. International Journal of Clinical Medicine, 3, 722-730. doi: 10.4236/ijcm.2012.37A127.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] D. Dewar, F. A. Moore, E. E. Moore and Z. Balogh, “Postinjury Multiple Organ Failure,” Injury, Vol. 40, No. 9, 2009, pp. 912-918. doi:10.1016/j.injury.2009.05.024
[2] B. Maier, R. Lefering, M. Lehnert, H. L. Laurer, W. I. Steudel, E. A. Neuge-bauer and I. Marzi, “Early versus Late Onset of Multiple Organ Failure Is Associated with Differing Patterns of Plasma Cyto-kine Biomarker Expression and Outcome after Severe Trauma,” Shock, Vol. 28, No. 6, 2007, pp. 668-674
[3] D. Dewar, N. Butcher, K. King and Z. Balogh, “Post Injury Multiple Organ Failure,” Trauma, Vol. 13, No. 1, 2011, pp. 81-91.
[4] D. J. Ciesla, E. E. Moore, J. L. Johnson, A. Sauaia, C. C. Cothren, J. B. Moore and J. M. Burch, “Multiple Organ Dysfunction during Resuscitation Is Not Postinjury Multiple Organ Failure,” Archives of Surgery, Vol. 139, No. 6, 2004, pp. 590-594. doi:10.1001/archsurg.139.6.590
[5] D. J. Ciesla, E. E. Moore, J. L. Johnson, et al., “The Role of the Lung in Postinjury Mul-tiple Organ Failure,” Surgery, Vol. 138, No. 4, 2005, pp. 749-757. doi:10.1016/j.surg.2005.07.020
[6] F. A. Moore, A. Sauaia, E. E. Moore, et al., “Postinjury Multiple Organ Failure: A Bi-modal Phenomenon,” Journal of Trauma, Vol. 40, No. 4, 1996, pp. 501-502. doi:10.1097/00005373-199604000-00001
[7] R. M. Durham, J. J. Moran, J. E. Mazuski, M. J. Shapiro, A. E. Baue and L. M. Flint, “Multiple Organ Failure in Trauma Patients,” Journal of Trauma, Vol. 55, No. 4, 2003, pp. 608-616. doi:10.1097/01.TA.0000092378.10660.D1
[8] R. Bone, R. Balk, F. Cerra, et al., “Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis: The ACCP/SCCM Consensus Conference Commit-tee—American College of Chest Physicians/Society of Critical Care Medicine,” Chest, Vol. 101, No. 6, 1992, pp. 1644-1655.
[9] J. Marshall, “A Scoring System for the Mul-tiple Organ Dysfunction Syndrome (MODS),” In: K. Rheinhart, K. Eyrich and C. Sprung, Eds., Sepsis: Current Perspectives in Pathophysiology and Therapy, Springer-Verlag, Berlin, 1994, pp. 38-49.
[10] J. Marshall, D. Cook, N. Christou, G. Bernard, C. Sprung and W. Sibbald, “Multiple Organ Dysfunction Score: A Reliable Descriptor of a Complex Clinical Outcome,” Critical Care Medicine, Vol. 23, No. 10, 1995, pp. 1638-1652.
[11] D. J. Ciesla, E. E. Moore, J. L. Johnson, J. M. Burch, C. C. Cothren and A. Sauaia, “A 12-Year Prospective Study of Postinjury Multiple Organ Failure: Has Anything Changed?” Archives of Surgery, Vol. 140, No. 5, 2005, pp. 432-438. doi:10.1001/archsurg.140.5.432
[12] F. A. Moore, A. Sauaia, E. E. Moore, et al., “Postinjury Multiple Organ Failure: A Bimodal Phenomenon,” Journal of Trauma, Vol. 40, No. 4, 1996, pp. 501-502. doi:10.1097/00005373-199604000-00001
[13] W. A. Knaus, E. A. Draper, D. P. Wagner and J. E. Zimmerman, “Prognosis in Acute Organ System Failure,” Annals of Surgery, Vol. 202, No. 6, 1985, pp. 685-693. doi:10.1097/00000658-198512000-00004
[14] E. Faist, A. E. Baue, H. Dittmer, G. Heberer, “Multiple Organ Failure in Poly-trauma Patients,” Journal of Trauma, Vol. 23, No. 9, 1983, pp. 775-787. doi:10.1097/00005373-198309000-00002
[15] D. E. Fry, L. Pearlstein, R. L. Fulton and H. C. Polk, “Multiple System Organ Failure: The Role of Uncontrolled Infection,” Archives of Surgery, Vol. 115, No. 2, 1980, pp. 136-140.
[16] H. G. Cryer, K. Leong, D. L. McArthur, et al., “Multiple Organ Failure: By the Time You Predict It, It’s Already There,” Journal of Trauma, Vol. 46, No. 4, 1999, pp. 597-604. doi:10.1097/00005373-199904000-00007
[17] L. E. Stevens, “Gauging the Severity of Surgical Sepsis,” Archives of Surgery, Vol. 118, No. 10, 1983, pp. 1190-1192. doi:10.1001/archsurg.1983.01390100060015
[18] R. J. Goris, T. P. te Boekhorst, J. K. Nuytinck and J. S. Gimbree, “Mul-tiple-Organ Failure: Generalized Autodestructive In?ammation?” Archives of Surgery, Vol. 120, No. 10, 1985, pp. 1109-1115. doi:10.1001/archsurg.1985.01390340007001
[19] J. L. Vincent, R. Moreno, J. Takala, et al., “The SOFA (Sepsis-related Organ Failure Assessment) Score to Describe Organ Dysfunc-tion/Failure,” Intensive Care Medicine, Vol. 22, No. 7, 1996, pp. 707-710. doi:10.1007/BF01709751
[20] J. R. Le Gall, J. Klar, S. Leme-show, et al., “ICU Scoring Group. The Logistic Organ Dys-function System: A New Way to Assess Organ Dysfunction in the Intensive Care Unit,” Journal of the American Medical Association, Vol. 276, No. 10, 1996, pp. 802-810. doi:10.1001/jama.1996.03540100046027
[21] A. Sauaia, E. E. Moore, J. L. Johnson, D. J. Ciesla, W. L. Biffl and A. Banerjee, “Validation of Postinjury Multiple Organ Failure Scores,” Shock, Vol. 31, No. 5, 2009, pp. 438-447. doi:10.1097/SHK.0b013e31818ba4c6
[22] T. Tsukamoto, R. S. Chanthaphavong and H. C. Pape, “Current Theories on the Pathophysiology of Multiple Organ Failure after Trauma,” Injury, Vol. 41, No. 1, 2010, pp. 21-26. doi:10.1016/j.injury.2009.07.010
[23] S. Oda, H. Hirasawa, T. Sugai, et al., “Comparison of Sepsis Related Organ Failure Assessment (SOFA) Score and CIS (cellular injury score) for Scoring of Severity For Patients with Multiple Organ Dysfunc-tion Syndrome (MODS),” Intensive Care Medicine, Vol. 26, No. 12, 2000, pp. 1786-1793. doi:10.1007/s001340000710
[24] V. Pettila, M. Pettila, S. Sarna, P. Voutilainen and O. Takkunen, “Comparison of Multiple Organ Dysfunction Scores in the Prediction of Hospital Mortality in the Critically Ill,” Critical Care Medicine, Vol. 30, No. 8, 2002, pp. 1705-1711. doi:10.1097/00003246-200208000-00005
[25] D. C. Dewar, P. Mackay and Z. Balogh, “Epidemiology of Post-Injury Multiple Organ Failure in an Australian Trauma System,” ANZ Journal of Surgery, Vol. 79, No. 6, 2009, pp. 431-436. doi:10.1111/j.1445-2197.2009.04968.x
[26] E. R. Zakaria, R. N. Garrison, D. A. Spain, P. J. Matheson, P. D. Harris and D. J. Richardson, “Intraperitoneal Resuscitation Improves Intestinal Blood Flow Following Hemorrhagic Shock,” Annals of Surgery, Vol. 237, No. 5, 2003, pp. 704-713. doi:10.1097/01.SLA.0000064660.10461.9D
[27] E. R. Zakaria, R. T. Hurt, P. J. Matheson and R. N. Garrison, “A Novel Me-thod of Peritoneal Resuscitation Improves Organ Perfusion after Hemorrhagic Shock,” American Journal of Surgery, Vol. 186, No. 5, 2003, pp. 443-448. doi:10.1016/j.amjsurg.2003.07.006
[28] E. R. Zakaria, J. E. Campbell, J. C. Peyton and R. N. Garrison, “Post-Resuscitation Tissue Neutrophil Infiltration Is Time-Dependent and Or-gan-Specific,” Journal of Surgical Research, Vol. 143, No. 1, 2007, pp. 119-125. doi:10.1016/j.jss.2007.04.008
[29] E. R. Zakaria, P. J. Mathe-son, M. F. Flessner and R. N. Garrison, “Hemorrhagic Shock and Resuscitation-Mediated Tissue Water Distribution Is Normalized by Adjunctive Peritoneal Resuscitation,” Journal of the American College of Surgeons, Vol. 206, No. 5, 2008, pp. 970-980. doi:10.1016/j.jamcollsurg.2007.12.035
[30] E. R. Zakaria, N. Li, P. J. Matheson and R. N. Garrison, “Cellular Edema Regulates Tissue Capillary Perfusion Following Hemorrhage Resus-citation,” Surgery, Vol. 142, No. 4, 2007, pp. 487-96. doi:10.1016/j.surg.2007.08.007
[31] E. A. Deitch, “Gut-Origin Sepsis: Evolution of a Concept,” The Surgeon, Vol. 10, No. 6, 2012, pp. 350-356. doi:10.1016/j.surge.2012.03.003
[32] Z. Lausevic, M. Lausevic and J. Trbojevic-Stankovic, “Predicting Multiple Organ Failure in Patients with Severe Trauma,” Canadian Journal of Surgery, Vol. 51, No. 2, 2008, pp. 97-102.
[33] R. M. Roumen, H. Redl and G. Schlag, “In?ammatory Mediators in Relation to the Development of Multiple Organ Failure in Patients after Severe Blunt Trauma,” Critical Care Medicine, Vol. 23, No. 3, 1995, pp. 474-480.
[34] P. V. Giannoudis, “Current Concepts of the Inflammatory Response after Major Trauma: An Update,” Injury, Vol. 34, No. 6, 2003, pp. 397-404.
[35] T. Visser, J. Pillay, L. Koenderman and L. P. Leenen, “Postinjury Immune Monitoring: Can Multiple Organ Failure Be Predicted?” Current Opinion in Critical Care, Vol. 14, No. 6, 2008, pp. 666-672. doi:10.1097/MCC.0b013e3283196522
[36] A. M. Ferreira and Y. Sakr, “Organ Dysfunction: General Approach, Epidemiology, and Organ Failure Scores,” Seminars in Respiratory and Criti-cal Care Medicine, Vol. 32, No. 5, 2011, pp. 543-551. doi:10.1055/s-0031-1287862
[37] R. M. Dorizzi, E. Polati and P. Sette, “Procalcitonin in the Diagnosis of Inflammation in Intensive Care Units,” Clinical Biochemistry, Vol. 39, No. 12, 2006, pp. 1138-1143.
[38] A. Luzzani, E. Polati and R. Dorizzi, “Comparison of Procalcitonin and C-Reactive Protein as Markers of Sepsis,” Critical Care Medicine, Vol. 31, No. 6, 2003, pp. 1737-1741. doi:10.1097/01.CCM.0000063440.19188.ED
[39] M. Krueger, A. Heinzmann and M. Nauck, “Adhesion Molecules in Pediatric Intensive Care Patients with Organ Dysfunction Syndrome,” Intensive Care Medicine, Vol. 33, No. 2, 2007, pp. 359-363. doi:10.1007/s00134-006-0453-6
[40] S. Hofer, T. Brenner, C. Bopp, J. Steppan, C. Lichtenstern, J. Weitz, T. Bruckner, E. Martin, U. Hoffmann and M. A. Weigand, “Cell Death Serum Biomarkers Are Early Predictors for Survival in Severe Septic Patients with Hepatic Dysfunction,” Critical Care, Vol. 13, No. 3, 2009, pp. R93. doi:10.1186/cc7923
[41] N. Kume, H. Mit-suoka, K. Hayashida and M. Tanaka, “Pentraxin 3 as a Biomarker for Acute Coronary Syndrome: Comparison with Biomarkers for Cardiac Damage,” Journal of Cardiology, Vol. 58, No. 1, 2011, pp. 38-45. doi:10.1016/j.jjcc.2011.03.006
[42] X. He, B. Han, X. Bai, Y. Zhang, M. Cypel, M. Mura, S. Keshavjee and M. Liu, “PTX3 as a Potential Biomarker of Acute Lung Injury: Supporting Evidence from Animal Experimentation,” Intensive Care Med-icine, Vol. 36, No. 2, 2010, pp. 356-364. doi:10.1007/s00134-009-1720-0
[43] M. Haase, P. Devarajan, A. Haase-Fielitz, et al., “The Outcome of Neutrophil Gelati-nase-Associated Lipocalin-Positive Subclinical Acute Kidney Injury: A Multicenter Pooled Analysis of Prospective Studies,” Journal of the American College of Cardiology, Vol. 57, No. 17, 2011, pp. 1752-1761. doi:10.1016/j.jacc.2010.11.051
[44] I. T. Klip, A. A. Voors, S. D. Anker, H. L. Hillege, et al., “OP-TIMAAL Investigators Prognostic Value of Mid-Regional Pro-Adrenomedullin in Patients with Heart Failure after an Acute Myocardial Infarction,” Heart, Vol. 97, No. 11, 2011, pp. 892-898.
[45] C. Kirchhoff, B. A. Leidel, S. Kirchhoff, V. Braunstein, V. Bogner, U. Kreimeier, W. Mutschler and P. Biberthaler, “Analysis of N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Index in Multiple Injured Patients: A Prospective Cohort Study,” Critical Care, Vol. 12, No. 5, 2008, p. R118. doi:10.1186/cc7013
[46] M. Poeze, Y. C. Luiking, P. Breedveld, S. Manders and N. E. Deutz, “Decreased Plasma Glutamate in Early Phases of Septic Shock with Acute Liver Dysfunction Is an Independent Predictor of Survival,” Clinical Nutrition, Vol. 27, No. 4, 2008, pp. 523-530. doi:10.1016/j.clnu.2008.04.006
[47] S. Hofer, T. Brenner, C. Bopp, et al., “Cell Death Serum Biomarkers Are Early Predictors for Survival in Severe Septic Patients with Hepatic Dys-function,” Critical Care, Vol. 13, No. 3, 2009, p. R93. doi:10.1186/cc7923
[48] P. Paulus, C. Jennewein and K. Za-charowski, “Biomarkers of Endothelial Dysfunction: Can They Help Us Deciphering Systemic Inflammation and Sepsis?” Biomarkers, Vol. 16, Suppl. 1, 2011, pp. S11-S21. doi:10.3109/1354750X.2011.587893

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