Multisystem Organ Failure

Multisystem organ failure, also referred to as multiple organ failure and multiple organ dysfunction syndrome, is defined as an illness in which two or more organ systems are not able to function without assistance or intervention. Examples of multisystem organ failure are congestive heart failure in the presence of acute respiratory failure, acute renal failure and liver failure due to septic shock, and acute respiratory failure requiring mechanical ventilation in patients in coma.

Multisystem organ failure generally results from infection, injury (accident or surgery) or reduced blood flow, as would occur during acute myocardial infarction or stroke, and these primary causes trigger an uncontrolled inflammatory response resulting in end-organ damage to vital organs, such as the heart, lungs, kidneys, bowel, brain and liver.

Sepsis, which results from a systemic inflammatory response resulting from an infection, is the most common cause of this condition. The inflammatory response of sepsis leads to a reduction in blood pressure and, subsequently, a reduction in blood flow to vital organs, further reducing their function. A definitive cause of the multisystem organ failure however, cannot be identified in up to one-third of patients.

Mortality rates from multisystem organ failure range from 30-100 percent, with the chance of survival decreasing as the number of organs involved increases. Once five organ systems are involved, the mortality rate is in the range of 95 percent, a figure that has remained unchanged since the 1980s.

Treatment of multisystem organ failure has been a major challenge, since the pathophysiology is not well understood. Currently, there is no specific treatment that can reverse organ failure, so treatment is therefore limited to supportive care such as supporting blood pressure and respiration. Maintaining adequate delivery of oxygen to various organs and maintaining tissue oxygenation is the overriding primary goal.

© James F. Lineback, MD, FCCP.  September 25, 2016