Multiple Organ Dysfunction Syndrome

What is multiple organ dysfunction syndrome?

Multiple organ dysfunction syndrome (MODS) is an acute (develops rapidly) and serious illness in which two or more organ systems stop working as they should. Organ systems are groups of organs that work together to perform essential functions in your body, such as breathing, digesting or urinating (peeing). MODS may make it difficult for your body to continue working without the help of life support. Life support helps do the work of your failing organs. MODS can affect any organ your body. The commonly affected organs include your:

• Lungs.
• Heart.
• Brain.
• Kidneys.
• Liver.
• Blood.

There are many causes of MODS. The most common cause is a serious infection (sepsis). MODS treatment focuses on treating the initial medical event (insult) while preventing serious injury to other organ systems.

MODS is a serious health condition. It’s often fatal without immediate treatment. Most people who develop MODS after a sudden insult must go to an intensive care unit (ICU) for close monitoring and life support.

Other names for MODS include:

• Multiple organ failure.
• Multiple organ system failure.

What organ systems can MODS affect?

Multiple organ dysfunction system involves two or more of any of the following organ systems:

• Respiratory system (lungs). Respiratory failure is when your lungs can no longer support your breathing needs, send enough oxygen to the other tissues in your body (hypoxia) or get carbon dioxide (CO2) out of your body (hypercapnia). With MODS, you may develop difficulty breathing and require mechanical ventilation to help you breathe. A serious type of lung injury in MODS is acute respiratory distress syndrome (ARDS). During ARDS, your lungs become stiff, and it may be hard to maintain a normal oxygen level in your blood.
• Cardiovascular system (heart). Your cardiovascular system transports blood through your body. Heart failure and circulatory shock (low blood pressure) is when your heart muscle is too weak or stiff to pump blood to the rest of your body. The widespread inflammation that associates with MODS may dilate your blood vessels and decrease blood flow to tissue organs. This may cause low blood pressure during MODS (shock). These blood vessels may also become leaky due to inflammation, which causes swelling (edema) in your body.
• Hematologic system (blood). MODS can cause an imbalance of certain blood parts (proteins). This imbalance can lead to bleeding and blood clots. You may develop skin bruises or internal bleeding in your stomach. The most serious hematologic system problem is disseminated intravascular coagulation (DIC). DIC may cause blood to ooze from sites where you have catheters or tubes in your skin.
• Neurologic system (brain). Your brain is an essential organ that controls your body systems. Brain failure (neurological failure) occurs when an injury to your brain or other part of your central nervous system (including your spinal cord and the nerves that serve and connect with your central nervous system) causes all or part of your brain to stop working. The spread of inflammation, clotting due to problems in your hematologic system and low blood circulation due to low blood pressure can reduce blood flow to your brain. This can lead to brain damage and delirium if you have MODS.
• Renal system (kidney). Kidney failure is when your kidney can’t perform some or all of its jobs, including filtering waste products out of your blood. The renal system filters your blood, creates pee and get rid of excess fluids in your body.
• Hepatic system (liver). Liver failure is when your liver can no longer perform some or all of its many functions, including cleaning toxins out of your blood, filtering out old red blood cells and making bile (a yellow/green acid that helps your body break down food). Inflammation and decreased blood flow to your liver can result in liver failure. It can cause your skin and/or eyes to look yellow. Liver failure can lead to other organ failures.

How common is multiple organ dysfunction syndrome?

MODS is common during acute critical illness. Studies report that MODS may occur in 28% to 88% of all critically ill people. It’s also the highest cause of death in people admitted to the surgical intensive care unit (ICU).

What are the early signs of multiple organ dysfunction syndrome?

MODS can affect every organ in your body. Therefore, the symptoms are specific to your affected organ. These symptoms may be mild during the early course of the illness that may result in MODS. They may also be severe. Symptoms you may experience as MODS develops from an acute illness include:

• Nausea and vomiting.
• Loss of appetite.
• Feeling very weak or tired.
• Fever.
• Chills.
• Confusion or difficulty concentrating.
• Quick, shallow breathing.
• Fast or irregular heartbeat.
• Long-lasting chest pain and/or abdominal pain.
• Abdominal swelling.
• Swelling in your extremities (hands and feet).
• Yellow tint to your skin or eyes (jaundice).
• Blue or gray/white tint to your skin, lips, tongue, gums, nails or eyes (cyanosis).
• Loss of consciousness.

What is multiple organ dysfunction syndrome caused by?

Any major illness, injury or infection can result in MODS. Healthcare providers and medical researchers aren’t sure of the exact reasons that lead to MODS. Current research suggests widespread inflammation and decreased blood flow are often responsible for MODS. MODS doesn’t only result from the initial insult. It also develops from events that involve many or all of your organ systems. Decreased blood flow and oxygen can lead to damage.

People may encounter multiple events during a severe illness that result in MODS. The first event is the triggering event, such as sepsis or major trauma (like a motor vehicle accident) or a serious heart attack.

The second event is when your immune system has a dangerous overreaction that causes widespread inflammation.

Finally, a third event may take place if you develop an infection, or you need surgery to treat the first event that causes your initial serious illness.

Some common causes of MODS include:

• Sepsis or septic shock. This may involve a serious bacterial or viral infection that leads to widespread inflammation.
• Traumatic injury. This may include a motor vehicle crash, severe burns or a stabbing or gunshot wound.
• Pancreatitis. Pancreatitis is inflammation of the pancreas. Causes may include gallstones, alcohol use disorder, certain medications and other factors.
• Massive heart attack. Heart attacks occur as a result of a blockage in a blood vessel that supplies blood to your heart.
• Liver failure. Liver failure causes may include hepatitis B, hepatitis C, fatty liver disease, alcohol use disorder and cirrhosis.
• Toxic injury and poisoning. Toxic injuries develop from exposure to poisonous substances (toxins). Examples may include acute or chronic drug or alcohol use, poisonous chemicals like pesticides and old insulation material (asbestos) and bacterial infections.

These conditions lead to significant changes within your immune and hematologic systems that affect other organs.

What organs fail first in multiple organ dysfunction syndrome?

Nearly all people with MODS initially have problems with their lungs. But healthcare providers and medical researchers don’t yet understand why lung dysfunction usually precedes MODS.

Who does multiple organ dysfunction syndrome affect?

Anyone can get MODS. But you may be at a higher risk of developing MODS if you have an underlying condition, such as a chronic disease or a disorder that affects your immune system (immunodeficiency).

How is multiple organ dysfunction syndrome diagnosed?

Healthcare providers may use different tests to diagnose organ failure throughout your body. These tests may include:

• Blood tests.
• Arterial blood gas
• Liver function tests.
• Kidney function tests.
• Blood and tissue cultures.
• Echocardiogram.
• Imaging tests, including an ultrasound or CT (computed tomography) scan.

How is multiple organ dysfunction syndrome treated?

MODS treatment depends on its causes and your affected organ systems. Some treatment options may include:

• Intravenous (IV) fluids to treat low blood flow.
• Vasopressor medications to increase blood flow through your blood vessels and tissues (tissue perfusion).
• Antibiotics to treat infection and/or sepsis.
• Blood transfusion to replace lost blood from an injury or surgery.
• Oxygen therapy to get your body more oxygen.
• Mechanical ventilation to help you breathe if you can’t breathe on your own.
• Dialysis to help your body remove waste products and excess fluid from your blood.
• Extracorporeal membrane oxygenation (ECMO) to add oxygen to your blood and remove CO2.
• A molecular absorbent recirculating system (MARS) to support the liver.
• Surgery for patients with severe injuries.
• Transplant surgery to replace a diseased or failing organ with a healthy one from a donor.
• Parenteral nutrition to provide your body nutrients through an IV or tube feeding (enteral nutrition) if you have gastrointestinal (GI) bleeding or a gastrointestinal disease that prevents you from eating or you’re physically unable to eat.

How soon after treatment will I feel better?

Your recovery depends on your underlying causes and treatment. A healthcare provider can give you a better idea of when you can expect to recover after treatment.

Can multiple organ dysfunction syndrome be prevented?

You can’t prevent some MODS causes and there’s currently no specific medication that helps to prevent MODS. Researchers have investigated ways to treat early MODS to prevent worsening illness. There are also several ongoing studies in this area.

You can help protect your organ systems by:

• Protecting your organs from trauma by wearing a seatbelt while in an automobile and by wearing protective padding while playing high-impact sports.
• Taking vaccines to prevent serious infections when recommended by your healthcare providers.
• Avoiding or limiting the use of medications outside of what your providers prescribe that can damage your kidneys, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
• Avoiding or limiting medications or other things that can cause bleeding in your stomach (stomach ulcers), such as NSAIDS, smoking and alcohol.
• Treating high blood pressure (hypertension).

If you’re in a hospital setting for the acute illness, your healthcare providers can help prevent worsening MODS by:

• Minimizing injury to your lungs from the ventilator.
• Restricting the use of blood transfusions until they’re necessary.
• Using blood thinners when necessary to prevent blood clots.

What is the outlook of multiple organ dysfunction syndrome?

Your MODS outlook depends on its causes. Sometimes some or all of your organs may recover. But you may need temporary life support as you recover.

Early recognition and treatment of MODS and its underlying cause are very important in successfully managing the condition.

The outlook for MODS also varies in different ICU settings. Healthcare providers consider the condition a frequent cause of death in people admitted to surgical ICUs.

Late-stage conditions may cause permanent damage to your organs. You may need long-term life support or a transplant. It may also be fatal.

More research is necessary to identify potential predisposing factors for MODS, which could result in a better outlook for people.

What is the survival rate of multiple organ dysfunction syndrome?

Healthcare providers and medical researchers estimate the MODS survival rate is 50% to 60%.

When should I see a healthcare provider?

It’s always a good idea to see a healthcare provider if you have a chronic condition and experience MODS symptoms that put you at risk for serious illness and organ failure. They can tell you what specific signs or symptoms to look out for and how to manage any conditions.

When should I go to the ER?

Go to the nearest emergency room or call 911 or your local emergency number if you have signs of MODS. It can be fatal without prompt medical treatment.

What questions should I ask a healthcare provider?

Questions you may want to ask your healthcare provider include:

• What caused MODS?
• What are my treatment options?
• What medications do you recommend?
• What are my goals of care?
• How often do I need treatment?

A note from Cleveland Clinic

Multiple organ system dysfunction is a severe condition that affects two or more organ systems in your body. MODS can affect any organ. But the primary organs include your lungs, heart, kidneys, liver, brain and blood. MODS has many causes, but the general categories include major trauma, severe illness and widespread infection. Treatment focuses on treating the initial insult and working to prevent severe injury to other organ systems.

It can be scary to hear that your organs or a loved one’s organs aren’t working. But healthcare providers in emergency rooms and intensive care units have training to support all of your organ systems, prevent further damage and help your body recover.