OBJECTIVETo develop a scoring system to measure the severity of the multiple organ dysfunction syndrome (MODS).

METHODSThe clinical data of patients with MODS were collected and analyzed prospectively. Seven indicators were screened out to assess the functions of seven organs. Each indicator was scored from 0 to 4 points, with the 0 point representing the normal organ function, and 1 point to 4 points representing the dysfuntion to failure of the organ. Acording to the index and points a severity scoring system were developed.

RESULTSSeven indicators including the systolic pressure, oxygenation index, conscious state, peripheral blood platelet count, blood total bilirubin, and serum creatinine were used to represent the functions of seven organs. The seven organs included cardiovascular system, lung, brain, coagulative system, liver, kidney, and gastrointestinal tract. The severity scoring system were composed of seven indicators and their points. The total score was 24 points. The mortality increased along with the increase of the points (P<0.001).

CONCLUSIONThis scoring system can be used to assess the severity of the MODS.

Humans ; Multiple Organ Failure ; diagnosis ; mortality ; physiopathology ; Severity of Illness Index

OBJECTIVETo investigate the severity related influencing factor and treatment strategy of severe acute pancreatitis with early organ dysfunction.

METHODSFrom July 2007 to December 2008, 167 patients with severe acute pancreatitis were treated in the Surgical Department of Ruijin Hospital. The relationships between the happening of early organ dysfunction and outcome of the patients were observed, with operative or nonoperative treatment strategy.

RESULTSAmong 167 patients, 68 patients have early organ dysfunction, in which 39 with single organ dysfunction and 29 with multiple organ dysfunction. The early organ dysfunction were involved in 47.1% in cardiovascular system, 35.3% in lung and 29.4% in kidney. Aging (P < 0.05) and higher APACHE II score (P < 0.05) predicted a poor prognosis, which were benefit from early operation.

CONCLUSIONSThe mortality of the patients with SAP is related to age, and the degree of organ dysfunction as well. In the first phase of the disease, the selection of operation depends on the trends and the degree of early organ dysfunction before infected necrosis happens, with the aid of SOFA score as a scale.

Acute Disease ; Aging ; Humans ; Multiple Organ Failure ; Pancreatitis ; diagnosis ; Prognosis

Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7%) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.
*Abdomen ; *Compartment Syndromes/diagnosis ; *Compartment Syndromes/etiology ; *Compartment Syndromes/surgery ; Decompression, Surgical ; *Multiple Organ Failure/diagnosis ; *Multiple Organ Failure/etiology ; *Multiple Organ Failure/surgery ; *Pancreatitis, Acute Necrotizing/complications ; *Pancreatitis, Acute Necrotizing/diagnosis ; *Pancreatitis, Acute Necrotizing/surgery

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

OBJECTIVE: To study the characteristics of the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome on plateau (H-ARDS/MODS) and compare the accuracy of the three MODS scoring criteria in predicting the outcome of syndrome. METHODS: Five hundred and forty cases fulfilling the criteria of MODS were divided into four groups according to the altitude of their inhabitation area: control group (on plain, CG, n=113, altitude: <430 m), moderate high altitude group 1 (H1G, n=314, altitude: 1,517 m), moderate high altitude group 2 (H2G, n=78, altitude: 2,261 m to 2,400 m) and high altitude group (HG, n=35, altitude: 2 808 m to 3 400 m). According to the diagnostic criteria of Lushan conference and Marshall (1995) commonly used on plain, and Lanzhou criteria drafted by the authors, three data analyzing models were set up to draw the receiver operating characteristic (ROC) curves, the Yordon Index and the optimum cutoff points of the parameters were calculated and the accuracy of the three respective diagnostic criteria was evaluated in predicting the outcome of ARDS/MODS. Multiple factors affecting the outcome of MODS were analyzed using the method of stepwise forward regress model. RESULTS: Following the increase in altitude, Lanzhou criteria was clearly superior to the other two criteria in the area of ROC, the sensitivity, the specificity, and also for the optimum cutoff points of MODS. Multi-variable regression analysis showed that the impacting factor of Lanzhou criteria was the highest (P<0.05). CONCLUSION: (1)Some parameters of the current diagnostic criteria of ARDS/MODS are not suitable in moderately high or high altitude areas. It is necessary to set up the diagnostic criteria of H-ARDS/MODS. (2)Some clinical characteristics might change in areas 1,500 m altitude or higher. The pathophysiological mechanism might be attributable to peculiar biologic reactions due to hypoxia stress reaction, and it is worth further study.
Altitude ; Multiple Organ Failure/*diagnosis ; Prognosis ; ROC Curve ; Regression Analysis ; Respiratory Distress Syndrome, Adult/*diagnosis ; Severity of Illness Index

Streptococcal toxic shock syndrome (TSS) is characterized clinically by shock and multiple organ failure, combined with invasive group A streptococcus (GAS) infection. Invasive GAS infection declined with the introduction of modern antibiotics, but has recently arisen again globally with severe presentations like TSS. Cases of streptococcal TSS have been reported in Korea since the 1990s and its prevalence may increase. We report the first case of GAS pneumonia initially presenting as streptococcal TSS, as a warning that this potentially fatal illness requires an early diagnosis and prompt treatment when patients with pneumonia develop shock and multiple organ failure.
Anti-Bacterial Agents ; Early Diagnosis ; Humans ; Korea ; Multiple Organ Failure ; Pneumonia* ; Prevalence ; Shock ; Shock, Septic* ; Streptococcus pyogenes ; Streptococcus*

We experienced two cases of Boerhaave syndrome (spontaneous esophageal rupture). The first patient was a 62-year-old male who presented epigastric pain after several violent vomitings associated with alcohol ingestion. Diagnosis was done early and promptly in our emergency center and then definitive treatment was done only after 12hrs from onset of his symptom and he was discharged in relatively good condition 256ays after his admission. The second patient was a 44-year-old male who was transfered to our emergency center with chest pain, dyspnea and fever after vomitings associated with autobicycle accident. Diagnosis was delayed due to initial trauma oriented evaluation and incidious develpement of typical clinical findings and then he was managed conservatively but he died of multiple organ failure due to sepsis. We report these cases with literature review.
Adult ; Chest Pain ; Diagnosis ; Dyspnea ; Eating ; Emergencies ; Esophageal Perforation* ; Fever ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis

OBJECTIVETo develop diagnostic criteria of multiple organ dysfunction syndrome (MODS) by a prospective and multi-center clinical investigation.

METHODSThe data of 1087 MODS cases obtained from ICU of 37 hospitals from March 2002 to January 2005 in 11 provinces in China were analyzed in order to derive the diagnostic criteria of MODS.

RESULTSThis MODS diagnostic criteria involved 7 organs. To diagnose MODS, the original cause of MODS should be identified, then there should be two or more organs showing signs of dysfunction. The criteria for organ dysfunction were as follows. (1) Cardiovascular system: SBP < 90 mm Hg (1 mm Hg = 0.133 kPa), MAP < 70 mm Hg, signs of shock, ventricular tachycardia, ventricular fibrillation, or myocardial infarction; (2) Respiratory system: oxygenation index < 300 mm Hg; (3) Nervous system: indifference, restlessness, lethargy, light coma, or deep coma, Glasgow score < or = 14; (4) Blood system: PLT < 100 x 10(9)/L; CT, APTT, and PT prolonged or shortened; positive plasma protamine paracoagulation; (5) Liver: TBIL > 20. 5 micromol/L, ALB < 28 g/L; (6) Kidney: Cr > 123.8 micromol/L, urinary volume < 500 ml/24 h; (7) Gastro-intestine: bowel sounds decreased or disappeared; retention in the stomach, or positive occult blood feces with dark stools or haematemesis; intraabdominal pressure (intravesical pressure) > or = 11 cm H2O (1 cm H2O = 0.098 kPa). Any organ function met with one of the above conditions was considered to have dysfunction.

CONCLUSIONSThis diagnostic criterion of multiple organ dysfunction syndrome has been developed by this research, but it needs to accumulate experience by clinical practice and to revise the diagnosis criteria.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; diagnosis ; Prospective Studies ; Young Adult

This article analyzed the medical records of two patients with Vibrio vulnificus primary sepsis who were admitted to the First Affiliated Hospital of Naval Medical University and reviewed the latest literature. On November 6, 2019, a 54-year-old male patient was admitted to the hospital. The patient's lower limbs were red, swollen, and painful with ecchymosis and hemorrhagic bullae after he ate freshwater products. The emergency fasciotomy was performed 3 h after admission, and the multiple organ failure occurred after operation. The patient was given up treatment 24 h after admission. On August 12, 2020, a 73-year-old male patient was admitted to the hospital. He was in shock state on admission and had hemorrhagic bullae on his right lower limb after he ate seafood. At 3 h post admission, he underwent emergency surgical exploration and amputation of right thigh. Six days later, he received negative pressure wound treatment on the stump. On the 13^th day post admission, his families forgo the active treatment and he died 15 d after admission. The two cases were both failed to be diagnosed at the first time, and the disease progressed rapidly. Necrotizing fasciitis and multiple organ failure occurred. After the diagnosis was confirmed, timely fasciotomy and high amputation were performed respectively. The microbiological examinations both reported Vibrio vulnificus. Although the 2 cases were not cured successfully, the course of disease and some indexes of patient with early amputation were better than those of patients with fasciotomy. Vibrio vulnificus is widely distributed and frequently detected in fresh water products. The pathogenic pathway is fuzzy and complex, and it is easy to be misdiagnosed. It is necessary to establish the treatment process of Vibrio vulnificus sepsis. Early and aggressive surgical intervention should be carried out as soon as possible, fasciotomy and debridement should be thorough, and the patients with hemorrhagic bullae should be amputated early. Postoperative comprehensive measures are also important for improving the survival rate of patients.
Aged ; Fasciitis, Necrotizing/surgery* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis/diagnosis* ; Vibrio Infections/pathology* ; Vibrio vulnificus

BACKGROUND: The aim of this study was to investigate whether obtaining serum procalcitonin (PCT) levels in patients with systemic inflammatory response syndrome (SIRS) helps the differential diagnosis between sepsis and non-sepsis and predicts disease severity in the emergency department (ED). METHODS: This prospective study enrolled 132 consecutive adult patients with SIRS who visited the ED. Serum C-reactive protein (CRP) levels and serum PCT levels were compared between sepsis and non-sepsis groups upon ED admission. Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were calculated, and their correlations with CRP and PCT levels were evaluated. The PCT and CRP levels were assessed to predict sepsis in terms of comparing receiver operating characteristic (ROC) curves. RESULTS: Eighty patients were included in the sepsis group. The levels of PCT and CRP in the sepsis group were significantly higher. In the sepsis group, the initial serum PCT correlated with the SOFA and MODS scores, and this also correlated in the non-sepsis group, but CRP did not. No differences were found when the PCT and CRP ROCs were compared. CONCLUSIONS: Correlation between PCT and severity in the non-sepsis group is considered to be clinically meaningless because of low levels. Additionally, PCT levels had similar diagnostic value for sepsis as CRP levels. PCT is recommended for prediction of severity in sepsis patients in ED, but not for differential diagnosis between sepsis and non-sepsis.
Adult ; APACHE ; C-Reactive Protein ; Calcitonin ; Diagnosis, Differential ; Emergencies ; Humans ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prospective Studies ; Protein Precursors ; ROC Curve ; Sepsis ; Systemic Inflammatory Response Syndrome