ConditionWhole body & general
Multi-Organ Failure (Multiple Organ Dysfunction Syndrome)
Multi-organ failure, or multiple organ dysfunction syndrome (MODS), is the failure of two or more organ systems, such as the lungs, kidneys, liver, heart, blood clotting and brain, in a critically ill person. It is most often caused by sepsis, but also by shock, major trauma, burns, pancreatitis and cardiac arrest. It is the leading cause of death in intensive care. Treatment supports each failing organ while the underlying cause is treated, and risk of death rises with each additional organ that fails.
Also called: Multiple organ dysfunction syndrome (MODS), multiple organ failure, multisystem organ failure, MOF
At a glance
- What it is
- Progressive dysfunction of two or more organs in critical illness.
- Main causes
- Sepsis (most common), shock, major trauma, burns, pancreatitis, cardiac arrest.
- Organs affected
- Lungs (ARDS), kidneys, liver, heart and circulation, blood clotting, brain, gut.
- How it is measured
- SOFA score in the ICU.
- Treatment
- Treat the cause plus organ support: ventilation, dialysis, blood pressure medicines, transfusions.
- Outlook
- Mortality rises with each failing organ. Survivors often need months of recovery.
When to get help
Call 911 or go to the ER
- Confusion, extreme drowsiness or difficulty waking with fever or infection
- Fast breathing, severe breathlessness, or blue or gray lips
- Cold, mottled or very pale skin, or a racing heart with feeling faint
- Passing very little or no urine for a day, especially with illness
- Unusual bleeding or a rash that does not fade when pressed
See a doctor within a day or two
- An infection that is getting worse despite antibiotics, with shivering, muscle pain or feeling much more unwell
- Fever or feeling unwell after recent surgery, a hospital stay or chemotherapy
Book a routine appointment
- After discharge from intensive care: persistent weakness, fatigue, memory problems, anxiety, low mood or breathlessness, which are part of post-intensive care syndrome
What happens in multi-organ failure
In MODS, a severe insult triggers a massive, poorly controlled inflammatory and clotting response throughout the body. Blood vessels leak, blood pressure falls, tiny clots form in small vessels, and cells cannot use oxygen properly. Organs, including some far from the original problem, stop working. Failure often follows a sequence, with the lungs commonly first, followed by the kidneys, liver, clotting system and brain.
Causes
- Sepsis and septic shock: the most common cause. Infection from pneumonia, the abdomen, urine or skin
- Shock from blood loss, heart failure or severe allergy
- Major trauma and burns
- Severe acute pancreatitis
- Cardiac arrest and prolonged low oxygen
- Major surgery complications
- Poisoning and drug overdose
- Massive transfusion
Older age, chronic illness, weakened immunity, malnutrition, and delays in treatment increase risk.
Organs involved and signs
| Organ system | Failure | Signs and measures |
|---|---|---|
| Lungs | ARDS, respiratory failure | Low oxygen, need for ventilation |
| Kidneys | Acute kidney injury | Rising creatinine, low urine output |
| Heart and circulation | Shock | Low blood pressure needing vasopressors |
| Liver | Liver failure | Jaundice, rising bilirubin, clotting problems |
| Blood | Low platelets, DIC | Bleeding, bruising, clots |
| Brain | Encephalopathy | Confusion, delirium, coma |
| Gut | Ileus, ischemia, bleeding | Feeding intolerance, bleeding |
The SOFA (Sequential Organ Failure Assessment) score grades six organ systems from 0 to 4 each. A higher or rising score predicts higher mortality.
Diagnosis and monitoring
MODS is recognized in the hospital through:
- vital signs and urine output
- blood gases and lactate
- blood counts and clotting tests
- kidney and liver function
- cultures to find infection
- imaging to find the source, such as CT scans
- continuous monitoring in intensive care
Treatment
There is no single treatment for MODS. Care focuses on:
Treating the cause
- antibiotics within an hour for suspected septic shock
- source control: draining abscesses, removing infected lines, surgery
- stopping bleeding, treating pancreatitis, reversing poisoning
Supporting failing organs
- Lungs: oxygen and lung-protective mechanical ventilation, prone positioning
- Circulation: IV fluids, vasopressors such as norepinephrine, sometimes inotropes
- Kidneys: dialysis (continuous renal replacement therapy)
- Blood: transfusions of blood, platelets or clotting factors
- Nutrition: feeding through a tube into the gut when possible
- Other: blood sugar control, sedation management, prevention of blood clots, ulcers and infections
Outlook
Mortality depends on the number of failing organs, their severity, age and underlying health. Death rates rise significantly with each additional organ failure. Survivors often face post-intensive care syndrome: muscle weakness, fatigue, cognitive problems, anxiety, depression and PTSD, sometimes lasting a year or more. Some have lasting kidney or lung damage. Rehabilitation, ICU follow-up clinics and family support help recovery.
Prevention
- recognize and treat sepsis early: know the signs and seek help quickly
- keep vaccinations up to date, including flu, pneumococcal and COVID-19
- prompt treatment of infections and injuries
- careful management of high-risk patients in hospital
Frequently asked questions
What causes multiple organ failure?
The most common cause is sepsis, the body's overwhelming response to infection. Other causes include shock from blood loss or heart failure, major trauma, severe burns, acute pancreatitis, cardiac arrest, poisoning and complications of major surgery.
Can someone survive multi-organ failure?
Yes. Many people survive, especially younger, previously healthy patients and when the cause is treated quickly. Survival falls as more organs fail. Recovery is often long and may involve rehabilitation for weakness, memory and mood problems.
What are the signs that organs are shutting down?
Signs include confusion or unresponsiveness, rapid breathing and low oxygen, very low blood pressure, cold mottled skin, little or no urine, yellowing of the skin, and abnormal bleeding. In hospital, blood tests and monitoring track each organ.
How long can a person live with multiple organ failure?
It varies widely. With intensive care support, people can be kept alive for days to weeks while organs recover. Some recover fully. If organs do not improve despite maximum support, the care team will discuss goals of care with the family.
Is multi-organ failure the same as sepsis?
No. Sepsis is a life-threatening response to infection that causes organ dysfunction. Multi-organ failure is when two or more organs fail, which sepsis commonly causes, but it can also result from trauma, burns, pancreatitis and other critical illnesses.
Sources
This guide was written from current patient and clinical guidance, including:
- Society of Critical Care Medicine: Surviving Sepsis Campaign International Guidelines (2021)
- The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3, JAMA 2016)
- National Institute of General Medical Sciences: Sepsis Fact Sheet
- MedlinePlus: Sepsis
- Merck Manual Professional: Multiple Organ Dysfunction Syndrome