Table 1 Classification of new-onset organ failure
From: Predicting the clinical trajectory in critically ill patients with sepsis: a cohort study
No dysfunction | Moderate dysfunction | Severe dysfunction | |
|---|---|---|---|
Central nervous system | Awake and non-delirious | Delirium (positive CAM-ICU score on ≥ 1 observation) or use of continuous sedation includes (but not limited to) the infusion of propofol and midazolam at any dose | Prolonged coma (unresponsiveness to verbal commands, both with or without the use of continuous intravenous sedation (RASS ≤ − 4 or GCS ≤ 8) for > 24 h) |
Cardiovascular | Hemodynamic stability without support | Arterial hypotension (SBP < 90 mmHg for > 2 h) or use of inotropes and vasopressors (continuous infusion of dobutamine, milrinone, and (nor)epinephrine at any dose or a serum lactate level > 2 mmol/L) or positive fluid balance (cumulative fluid intake minus output > 2 L/24 h) | Shock (use of high-dose vasopressors including (nor)epinephrine at > 0.1 μg/kg/min or arginine vasopressin at any dose for > 12 h, with concurrent positive fluid balances > 2 L/24 h and lactatemia > 2 mmol/L) |
Respiratory | Spontaneous breathing without hypoxemia | Mild arterial hypoxemia (use of mechanical ventilation with a P/F ratio < 300 and PEEP > 5 cm H2O) | Severe arterial hypoxemia (P/F ratio < 200 despite mechanical ventilation with PEEP > 8 cm H2O) |
Renal | Adequate diuresis with preserved GFR | Acute oliguria (urine output < 0.5 ml/kg/h for > 6 h, or < 500 ml per day) or GFR decrease > 50% (> 1.5-fold increase in serum creatinine from baseline) | Prolonged oliguria/anuria (urine output < 0.3 ml/kg/h for > 24 h, or < 200 ml per day) or GFR decrease > 75% (> 3-fold increase in serum creatinine from baseline, a single creatinine level > 350 μmol/L with an acute rise of > 44 μmol/L, or use of renal replacement therapy) |
Coagulation | Normal hemostasis | Mild thrombocytopenia (platelet count < 100,000/μL) or abnormal coagulation (INR > 1.5 or APTT > 60 s) | Severe thrombocytopenia (platelet count < 50,000/μL) |
Liver | Normal liver function | Mild hyperbilirubinemia (plasma total bilirubin > 30 μmol/L) or abnormal protein synthesis (plasma albumin concentration < 20 g/L) or mild transaminitis (AST or ALT blood levels > 500 U/L) | Severe hyperbilirubinemia (plasma total bilirubin > 100 μmol/L) or severe transaminitis (AST or ALT blood levels > 1000 U/L) or deficient protein synthesis (plasma albumin concentration < 15 g/L) |
Gastro-intestinal | Normal gut function | Impaired enteral feeding (daily caloric intake < 50% of calculated needs) | Prolonged food intolerance (inability to provide enteral feeding due to high gastric aspirate volume, vomiting, bowel distension, severe diarrhea, intraabdominal hypertension or abdominal compartment syndrome for > 24 h) |