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Table 1 Classification of new-onset organ failure

From: Predicting the clinical trajectory in critically ill patients with sepsis: a cohort study

 No dysfunctionModerate dysfunctionSevere dysfunction
Central nervous systemAwake and non-deliriousDelirium (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 doseProlonged coma (unresponsiveness to verbal commands, both with or without the use of continuous intravenous sedation (RASS ≤ − 4 or GCS ≤ 8) for > 24 h)
CardiovascularHemodynamic stability without supportArterial 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)
RespiratorySpontaneous breathing without hypoxemiaMild 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)
RenalAdequate diuresis with preserved GFRAcute 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)
CoagulationNormal hemostasisMild thrombocytopenia (platelet count < 100,000/μL) or abnormal coagulation (INR > 1.5 or APTT > 60 s)Severe thrombocytopenia (platelet count < 50,000/μL)
LiverNormal liver functionMild 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-intestinalNormal gut functionImpaired 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)
  1. In cases where definitions were not mutually exclusive, the worst level of organ dysfunction was assigned
  2. Abbreviations: ALT alanine transaminase, APTT activated partial thromboplastin time, AST aspartate transferase, CAM-ICU confusion assessment method for the intensive care unit, GCS Glasgow coma scale, GFR glomerular filtration rate, INR international normalized ratio, PEEP positive end-expiratory pressure, P/F partial pressure arterial oxygen and fraction of inspired oxygen, RASS Richmond agitation sedation scale, SBP systolic blood pressure