English

Abstract

Multiple organ dysfunction syndrome (MODS) is a systemic, dysfunctional inflammatory response that requires longer admissions in acute medical care unit with high mortality rate. The present study was done prospectively to evaluate clinical profile and etiological spectrum of patients admitted in acute medical care unit categorized under multi- organ dysfunction syndrome (MODS) and to correlate outcome of MODS. 50 patients of ≥ 18 years age who were admitted in Acute Medical Care Unit, Department of Medicine, Government General Hospital, Kakinada, with more than one organ dysfunction, requiring intervention were studied during 2010-2012. In all cases provisional diagnosis was made by taking detailed history and clinical examination, and were subjected to the relevant investigations. The criteria were used to include under MODS were assessed on respiratory, renal gastrointestinal, central nervous system, Glasgow coma scale cardiovascular, hematological parameters. The outcome of MODS was correlated by application of APACHE-II score on admission day, serial SOFA score on day 1 and 3, serial serum albumin measurement on day 1 and 5. There was multiorgan involvement .Most common organ failed was renal 30 (60%), followed by CNS 27 (54%), respiratory 25 (50%), CVS 23 (46%), GIT 17 (34%), hematologic 9 (18%). Sepsis was the most common cause of MODS in 24 (48%) patients. Most common organ dysfunction as a predictor of mortality was CNS in 17 (77%) out of 22 patients expired, followed by Respiratory in 13 (59%), Renal 11 (50%), CVS 10 (45%), GIT 9 (40%), Hematologic 2 (9%). Maximum incidence of mortality was seen when ≥5 organs failed. There was significant correlation statistically in our study between APACHE II score on admission and outcome as Pearson chi-square “p”< 0.001Mean SOFA score of survivors on day 1 was 6±2 and on day 3 was 2±1. Mortality significantly decreased (3.44%) on day 3 if SOFA score was ≤7. Multi-Organ Dysfunction Syndrome (MODS) was common in younger age group with the mean age of40 years. Sepsis (48%) was the most common cause of MODS, followed by other causes. Maximum incidence of mortality (55%) was seen if the first failed organ was respiratory system and when ≥5 organs failed. Highest incidence of mortality was seen in 8 th decade (100%). APACHE II score on admission, serial SOFA scores, and serial albumin measurements can help ICU physicians in admitting patients, monitoring the clinical course, assessment of organ dysfunction, predicting mortality and for transferring patients out from ICU and thus in proper utilization of ICU resources.