Survival in fully manifest multiple organ dysfunction syndrome.

BACKGROUND

Multiple organ dysfunction syndrome (MODS) is the leading cause of death in intensive care units throughout the world. Several composite clinical scores, such as the Multiple Organ Dysfunction (MOD) score and Sequential Organ Failure Assessment (SOFA) score, have been developed to assess the severity of critical illness and predict mortality. Survival in fully manifest MODS is nearly unprecedented.

METHODS

Case report and review of the relevant literature.

CASE REPORT: A 55-year-old male was admitted to the neurologic intensive care unit with left lateral medullary syndrome, and access for permanent enteral feeding was indicated. On day 7 of the patient's hospitalization an attempt was made to place a gastrostomy tube in the patient, but the procedure was aborted after unexplained intra-operative hemodynamic instability. Eight days later the patient developed florid MODS of unclear etiology. His daily MOD and SOFA scores peaked at 16 and 20, respectively, and his cumulative MOD and SOFA scores peaked at 19 and 22, respectively, portending 100% mortality. Over the next 6 wks the patient gradually recovered nearly all organ function, until both his MOD and SOFA scores decreased to 1. He was discharged to a sub-acute rehabilitation facility.

CONCLUSIONS

This patient is the oldest patient reported to have survived fully manifest MODS. Whereas scoring systems such as the MOD and SOFA systems can be useful tools, they have several limitations and their results must be interpreted with caution.