Use of the modified MODS score in septic patients in the emergency department
© BioMed Central Ltd 2005
Published: 9 June 2005
The Multiple Organic Dysfunction Index was developed in a sample of surgical patients, and since then has been shown as a good predictive method in patients with septic shock. Six organic systems were chosen and quantified from zero to four, using the greater value from 24 hours. The calculation of the cardiovascular variable using the pressure-adjusted heart rate leads to a lack of simplicity in the utilization of this index at the bedside. In an attempt to make the calculation of the cardiovascular component easier, the same group that has developed the MODS index has shown a modification in this cardiovascular element in which there was no need for central venous pressure measurement and in which was included the evaluation of vasopressor use and lactate level. The objective of this study was to evaluate the discriminatory capacity of MODS for septic patients in the emergency room.
Materials and methods
A contemporary cohort study in adult patients with severe sepsis during a 6-month period in the emergency department (ED) of a tertiary hospital. We use the definitions of the SCCM/ACCP consensus conference for the diagnosis of severe sepsis.
There were 342 patients included with a hospital mortality rate of 64%. The mean age was 73.7 ± 13.6 years. The mean values of modified MODS, SOFA and APACHE II scores were 4.9 ± 3.0, 5.4 ± 2.9 and 20.5 ± 7.1, respectively. There was a good correlation between modified MODS and SOFA scores using the Pearson's correlation coefficient (R2 = 0.80; P < 0.0001). The areas under the ROC curve for modified MODS, SOFA and APACHE II scores were 0.71, 0.71 and 0.75, respectively. The optimal cut point to modified MODS was 4 (sensitivity [S] 71.6%, specificity [P] 58.5%, positive predictive value [PPV] 75.4% and negative predictive value [NPV] 46.2%), being 5 to SOFA (S 68.0%, P 63.4%, PPV 76.8% and NPV 47.2%) and being 18 to APACHE II (S 76.7%, P 60.2%, PPV 77.4% and NPV 41.0%).
The modified MODS score presents a good correlation with the SOFA score and a good discriminatory capacity in patients with severe sepsis in the ED.