Table 2. Diagnostic criteria of multiple organ dysfunction syndrome (MODS) according to Goldstein et al (8).

MODS is defined as the concurrent dysfunction of two or more systems. Each organ failure or dysfunction is defined by meeting one or more criteria of each organ system.

(Age-specific ranges for physiologic and laboratory variables at the end of this table.)

Respiratory dysfunction.§
PaO2/FiO2 < 300 torr in absence of cyanotic heart disease or preexisting lung disease OR PaCO2 > 65 torr or 20 mm Hg over baseline PaCO2 OR Proven need† for > 50% FiO2 to maintain saturation ≥ 92% OR Need for non-elective invasive or non-invasive ventilation
Cardiovascular dysfunction. Despite administration of intravenous fluid bolus ≥ 40 mL/kg in 1 hr: Decrease in BP (hypotension) < 5th percentile for age or systolic BP < 2 SD below normal for age (see Table) OR Need for vasoactive drug to maintain BP in normal range (dopamine > 5 μg/kg/min or dobutamine, epinephrine, or norepinephrine at any dose) OR Two of the following: Unexplained metabolic acidosis: base deficit > 5.0 mEq/L Increased lactate > 2 times upper limit of normal Oliguria: urine output < 0.5 mL/kg/hr Prolonged capillary refill: > 5 seconds Core to peripheral temperature gap > 3°C
Hematological dysfunction. Platelet count < 80,000/mm3 (< 80 × 109/L) or a decline of 50% in platelet count from highest value recorded over the past 3 days (for chronic hematology/oncology patients) OR INR (International Normalized Ratio) > 2
Neurological dysfunction. Glasgow Coma Score ≤ 11 OR Acute change in mental status with a change in Glasgow Coma Score ≥ 3 points from abnormal baseline
Hepatic dysfunction. Total bilirubin ≥ 4 mg/dL (not applicable for newborn) OR ALT 2 times upper limit of normal for age
Renal dysfunction. Serum creatinine ≥ 2 times upper limit of normal for age or 2 fold increase in baseline creatinine

^†Proven need assumes O₂ requirement was tested by decreasing flow with subsequent increase in flow if required.

^‡ALT = alanine transaminase (SGPT)

^ΨIn postoperative patients, this requirement can be met if the patient has developed an acute inflammatory or infectious process in the lungs that prevents him or her from being extubated.

^§Acute respiratory distress syndrome (ARDS) by these criteria must include a PaO₂/FiO₂ ratio ≤ 200 mm Hg, bilateral infiltrates, acute onset, and no evidence of left heart failure. Acute lung injury (ALI) is defined identically except the PaO₂/FiO₂ ratio is 201–300 mm Hg.

BP = Blood pressure

SD = Standard deviation