Organ dysfunction in patients with severe sepsis
Background: Severe sepsis is defined as sepsis plus organ dysfunction. There is a need to quantify this dysfunction, and several scoring systems have been developed.
Method: Review of the pertinent English-language literature.
Results: Early scoring of organ failure simply counted the number of failing organs, but the degree of dysfunction is an important variable. The first system to grade dysfunction was the multiple organ dysfunction score (MODS). The drawback of MODS is the variable used to quantify cardiovascular failure. To alleviate this limitation, the Brussels score was developed. However, it, too, was suboptimal and was replaced by the sequential or sepsis-related organ failure assessment (SOFA) score. There is a clear correlation between the total SOFA score and the mortality rate, and in certain studies, the total SOFA score was at least as good as traditional methods of predicting death. A key advantage of these simple scores is that they can be repeated to follow the course of organ dysfunction. The evolution of the SOFA score has been used to demonstrate the effects of various therapeutic interventions.
Conclusion: Quantifying organ dysfunction in patients with sepsis can assist in assessing prognosis and determining treatment effectiveness. The simplicity, reliability, and reproducibility of current scores facilitate their widespread use.
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