MODS

Overview

The Multiple Organ Dysfunction Score was developed to provide a standardised, reproducible measure of organ dysfunction for use in clinical outcome research and daily ICU monitoring. Each of the six systems is independently scored 0–4, giving a maximum total of 24. Higher scores correlate with higher predicted mortality. The score is designed to be calculated daily, allowing tracking of organ dysfunction trajectory over the ICU stay.

Organ Scoring

System	Parameter	Score 0	Score 1	Score 2	Score 3	Score 4
Respiratory	PaO₂/FiO₂ (mmHg)	> 300	226–300	151–225	76–150	≤ 75
Renal	Creatinine (µmol/L)	≤ 100	101–200	201–350	351–500	> 500
Hepatic	Bilirubin (µmol/L)	≤ 20	21–60	61–120	121–240	> 240
Cardiovascular	PAR = (HR × CVP) / MAP	≤ 10	10.1–15	15.1–20	20.1–30	> 30
Hematologic	Platelets (×10³/µL)	> 120	81–120	51–80	21–50	≤ 20
Neurologic	Glasgow Coma Scale	15	13–14	10–12	7–9	≤ 6

Total Score Interpretation

MODS Total	Severity	Predicted Mortality
0	No dysfunction	~0 %
1–4	Mild	~1–2 %
5–8	Moderate	~5–10 %
9–12	Severe	~25 %
13–16	Very severe	~50 %
> 16	Extreme	> 75 %

Clinical Notes

• Calculate daily using worst values in each 24-hour period to track trajectory.
• The cardiovascular component requires the Pressure-Adjusted Heart Rate (PAR = HR × CVP / MAP); central venous pressure measurement is necessary.
• The neurologic component (GCS) may be confounded by sedation — document sedation level alongside GCS when possible.
• MODS was designed as a research tool; for bedside severity assessment, SOFA is more commonly used in contemporary practice.

Literature

Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–1652.