A simple multiple system organ failure (MSOF) score may predict mortality of patients
who have sepsis syndrome. Using an MSOF scoring system, we prospectively determined
the presence or absence of respiratory, cardiovascular, renal, hepatic, gastrointestinal,
hematologic, and neurologic organ failure on day 1 of sepsis syndrome in 154 consecutive
patients who had sepsis syndrome in the ICU of a tertiary care, teaching hospital.
We used 30-day hospital mortality as the primary outcome variable. Overall 30-day
mortality was 34 percent. There was a strong linear association between number of
organ system failures and 30-day mortality (p < 0.0001). Mortality was 20 percent
in patients who had less than 3 organ system failures (n = 111) and 70 percent in
patients who had 3 or more organ system failures (n = 43). Survival was assessed using
the Cox proportional hazards model and was found to be significantly different (p
< 0.01) between the two groups defined by the aforementioned dichotomy after adjustment
for age and sex using time to death as the primary outcome. The increase in relative
risk of death associated with 3 or more organ system failures was 2.77 (95 percent
confidence interval, 2.74 to 2.83). Using logistic regression, the adjusted odds ratios
(OR) for covariates most predictive of mortality were hematologic (OR = 6.2), neurologic
(OR = 4.4), hepatic (OR = 3.4), cardiovascular (OR = 2.6), and age (1.05 per year).
The logistic model using the seven organ system failures and age as covariates accurately
predicted outcome 75 percent of the time with a sensitivity of 51 percent and specificity
of 87 percent. In conclusion, a simple scoring system tabulating the number of organ
system failures present on day 1 of sepsis syndrome predicts the mortality of patients
who have sepsis syndrome with reasonable accuracy.