Expanded Multiple Organ Dysfunction score: is it better than the Sequential Organ Failure Syndrome score?

In our database, the day 1 Sequential Organ Failure Syndrome (SOFA) score performs significantly better than day 1 Multiple Organ Dysfunction score (MODS) in outcome prediction (data not published). The Expanded Multiple Organ Dysfunction score (EMODS) is a simple modification of MODS. It is calculated by summing up MODS with the Organ Support/Failure Score (OS-F). The OS-F is a dichotomous score of 1 or 0, given to each organ support/failure the patient received, namely: mechanical ventilation present at the 24th hour of admission, inotropes for more than 1 hour/day, transfusion and serum creatinine >200 μmol/l. The Maximum score a patient could receive is 4. The above modifications seem necessary for MODS as it does not account for therapeutic interventions.

Objective

To compare performances of EMODS with SOFA in outcome prediction.

Design

Retrospective analysis of prospectively collected data as part of the APRiMo study [1].

Patients and methods

All critically ill obstetric patients admitted to our independent multidisciplinary ICU were included. Exclusion criteria: length of stay <24 hours. Necessary data for calculation of the MODS, SOFA and OS-F Score at the first day of ICU hospitalization were available. Main outcome of interest: vital status at ICU discharge. Performances of EMODS and SOFA were assessed using adequate statistical tests.

Results

Six hundred and forty patients were included in the analysis. Mortality rate 13.3%. Mean age 31 ± 6 years. Mean length of stay 5 ± 5 days. Mean MODS 4.3 ± 3.8, mean SOFA score 4.9 ± 4.2, mean EMODS 5.1 ± 4.6. Nonsurvivors vs survivors: mean SOFA score 11.5 ± 4.9 vs 3.9 ± 3 (P < 0.001), mean EMODS 12.3 ± 4.9 vs 3.9 ± 3.8 (P < 0.001) (Table 1).

Table 1

Discussion and conclusion

EMODS sensitivity was significantly better than MODS and performed at least as well as the SOFA score. Adding organ support enhanced the performance of MODS, sustaining organ dysfunction/failure assessment with SOFA (which involves mechanical ventilation and use of inotropes) is a better way to evaluate respiratory and hemodynamic dysfunctions. The choice of transfusion as an additional criterion to assess hematologic dysfunction is pertinent in our particular case mix. After computing a logistic regression model with OS-F components, single-component MODS, with vital status as the dependent variable; a serum creatinine level >200 μmol/l gave an OR of 23. This emphasizes again the importance of acute renal failure as a prognostic factor in the ICU, but also rises again the question about the optimal parameter to evaluate renal organ dysfunction.