More commonly, organ dysfunction is described as a process occurring over time. This approach has been almost universally employed in studies of multiple organ failure in which the number of failing systems are counted independent of whether these failures occur concurrently or sequentially. Aggregate scores are calculated by taking the worst values for each variable over a defined time, usually the entire ICU stay. Just as ICU prognosis is a function of the number of failing systems, so there is a strong correlation between aggregate organ dysfunction scores and ultimate ICU or hospital mortality ( Fig 1).
Fig. 1 Incremental increases in aggregate MOD scores are associated with increased ICU mortality: gray bars, patients in the first (developmental) half of the MOD score data set; green bars, patients in the second (validation) half of the MOD score data set. (Reproduced with permission from Marshay.. eia/ (19.9.5..).)
Although it has been customary to evaluate organ dysfunction over the entire ICU stay, the cumulative evolution of organ system dysfunction over any particular interval can also be assessed (Table ?). Such a measure provides an estimate of the time course and magnitude of deteriorating organ function.
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