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VOLUME 20 , ISSUE 10 ( 2016 ) > List of Articles


Early detection of nonneurologic organ failure in patients with severe traumatic brain injury: Multiple organ dysfunction score or sequential organ failure assessment?

Sara Ramtinfar, Shahrokh Chabok, Aliakbar Chari, Zoheir Reihanian, Ehsan Leili, Arsalan Alizadeh

Keywords : Multiple organ dysfunction syndrome, organ failure, sequential organ failure assessment, traumatic brain injury

Citation Information : Ramtinfar S, Chabok S, Chari A, Reihanian Z, Leili E, Alizadeh A. Early detection of nonneurologic organ failure in patients with severe traumatic brain injury: Multiple organ dysfunction score or sequential organ failure assessment?. Indian J Crit Care Med 2016; 20 (10):575-580.

DOI: 10.4103/0972-5229.192042

License: CC BY-ND 3.0

Published Online: 01-09-2017

Copyright Statement:  Copyright © 2016; The Author(s).


Objective: The aim of this study is to compare the discriminant function of multiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) components in predicting the Intensive Care Unit (ICU) mortality and neurologic outcome. Materials and Methods: A descriptive-analytic study was conducted at a level I trauma center. Data were collected from patients with severe traumatic brain injury admitted to the neurosurgical ICU. Basic demographic data, SOFA and MOD scores were recorded daily for all patients. Odd′s ratios (ORs) were calculated to determine the relationship of each component score to mortality, and area under receiver operating characteristic (AUROC) curve was used to compare the discriminative ability of two tools with respect to ICU mortality. Results: The most common organ failure observed was respiratory detected by SOFA of 26% and MODS of 13%, and the second common was cardiovascular detected by SOFA of 18% and MODS of 13%. No hepatic or renal failure occurred, and coagulation failure reported as 2.5% by SOFA and MODS. Cardiovascular failure defined by both tools had a correlation to ICU mortality and it was more significant for SOFA (OR = 6.9, CI = 3.6-13.3, P < 0.05 for SOFA; OR = 5, CI = 3-8.3, P < 0.05 for MODS; AUROC = 0.82 for SOFA; AUROC = 0.73 for MODS). The relationship of cardiovascular failure to dichotomized neurologic outcome was not significant statistically. ICU mortality was not associated with respiratory or coagulation failure. Conclusion: Cardiovascular failure defined by either tool significantly related to ICU mortality. Compared to MODS, SOFA-defined cardiovascular failure was a stronger predictor of death. ICU mortality was not affected by respiratory or coagulation failures.

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  1. Peres Bota D, Melot C, Lopes Ferreira F, Nguyen Ba V, Vincent JL. The multiple organ dysfunction score (MODS) versus the sequential organ failure assessment (SOFA) score in outcome prediction. Intensive Care Med 2002;28:1619-24.
  2. Wang H, Ma S. The cytokine storm and factors determining the sequence and severity of organ dysfunction in multiple organ dysfunction syndrome. Am J Emerg Med 2008;26:711-5.
  3. Gadkary CS, Alderson P, Signorini DF. Therapeutic hypothermia for head injury. Cochrane Database Syst Rev 2002;1:CD001048.
  4. Lim HB, Smith M. Systemic complications after head injury: A clinical review. Anaesthesia 2007;62:474-82.
  5. Zygun DA, Kortbeek JB, Fick GH, Laupland KB, Doig CJ. Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med 2005;33:654-60.
  6. Khwannimit B. A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients. J Med Assoc Thai 2007;90:1074-81.
  7. Zygun D, Berthiaume L, Laupland K, Kortbeek J, Doig C. SOFA is superior to MOD score for the determination of non-neurologic organ dysfunction in patients with severe traumatic brain injury: A cohort study. Crit Care 2006;10:R115.
  8. Marshall J. Multiple organ dysfunction syndrome. In: Sibbald WJ, Vincent JL, editors. Clinical Trials for the Treatment of Sepsis. 2 nd ed. Berlin: Springer-Verlag Press; 2012. p. 122-39.
  9. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in Intensive Care Units: Results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European society of intensive care medicine. Crit Care Med 1998;26:1793-800.
  10. Berthiaume L, Zygun D. Non-neurologic organ dysfunction in acute brain injury. Crit Care Clin 2006;22:753-66.
  11. Zygun D. Non-neurological organ dysfunction in neurocritical care: Impact on outcome and etiological considerations. Curr Opin Crit Care 2005;11:139-43.
  12. Ulvik A, Kvåle R, Wentzel-Larsen T, Flaatten H. Multiple organ failure after trauma affects even long-term survival and functional status. Crit Care 2007;11:R95.
  13. Zygun DA, Doig CJ, Gupta AK, Whiting G, Nicholas C, Shepherd E, et al. Non-neurological organ dysfunction in neurocritical care. J Crit Care 2003;18:238-44.
  14. Haddad SH, Arabi YM. Critical care management of severe traumatic brain injury in adults. Scand J Trauma Resusc Emerg Med 2012;20:12.
  15. Roberts DJ, Hall RI, Kramer AH, Robertson HL, Gallagher CN, Zygun DA. Sedation for critically ill adults with severe traumatic brain injury: A systematic review of randomized controlled trials. Crit Care Med 2011;39:2743-51.
  16. Hasenfuss G, Teerlink JR. Cardiac inotropes: Current agents and future directions. Eur Heart J 2011;32:1838-45.
  17. Cotton BA, Snodgrass KB, Fleming SB, Carpenter RO, Kemp CD, Arbogast PG, et al. Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma 2007;62:26-33.
  18. Dujardin KS, McCully RB, Wijdicks EF, Tazelaar HD, Seward JB, McGregor CG, et al. Myocardial dysfunction associated with brain death: Clinical, echocardiographic, and pathologic features. J Heart Lung Transplant 2001;20:350-7.
  19. Gonzalvo R, Martí-Sistac O, Blanch L, López-Aguilar J. Bench-to-bedside review: Brain-lung interaction in the critically ill - a pending issue revisited. Crit Care 2007;11:216.
  20. Diringer MN, Axelrod Y. Hemodynamic manipulation in the neuro-Intensive Care Unit: Cerebral perfusion pressure therapy in head injury and hemodynamic augmentation for cerebral vasospasm. Curr Opin Crit Care 2007;13:156-62.
  21. Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, et al. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma 2003;55:106-11.
  22. Corral L, Javierre CF, Ventura JL, Marcos P, Herrero JI, Mañez R. Impact of non-neurological complications in severe traumatic brain injury outcome. J Crit Care 2012;16:R44.
  23. Henderson WR, Dhingra VK, Chittock DR, Fenwick JC, Ronco JJ. Hypothermia in the management of traumatic brain injury. A systematic review and meta-analysis. Intensive Care Med 2003;29:1637-44.
  24. Bronchard R, Albaladejo P, Brezac G, Geffroy A, Seince PF, Morris W, et al. Early onset pneumonia: Risk factors and consequences in head trauma patients. Anesthesiology 2004;100:234-9.
  25. Mascia L. Acute lung injury in patients with severe brain injury: A double hit model. Neurocrit Care 2009;11:417-26.
  26. Larson BE, Stockwell DW, Boas S, Andrews T, Wellman GC, Lockette W, et al. Cardiac reactive oxygen species after traumatic brain injury. J Surg Res 2012;173:e73-81.
  27. Ley EJ, Berry C, Mirocha J, Salim A. Mortality is reduced for heart rate 80 to 89 after traumatic brain injury. J Surg Res 2010;163:142-5.
  28. Vincent JL, Moreno R. Clinical review: Scoring systems in the critically ill. J Crit Care 2010;14:207.
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