Multiple Organ Dysfunction Syndrome

Before diving deeper into what constitutes multiple organ dysfunction syndrome, it should be clarified that instead of being a single event, it is more of a series of events, with varying degrees of severity in the alteration of organs. The syndrome involves the failure of at least two organ systems, and it is directly related to inflammation from a severe infection or injury. Therefore, most people who have experienced, for instance, a severe septic shock or a major traumatic event are more prone to develop this syndrome. During sepsis, there is disturbed perfusion of microcirculation, tissue-toxicity, and systemic hypotension. These three can influence the way an organ would function normally, and if there is a negative impact, it would lead to organ failure. Multiple organ dysfunction syndrome is a condition that is associated with both high morbidity and mortality rates.

The major organs that are affected are the kidneys, liver, lungs, heart, and the brain. Kidney failure can be separated into acute and chronic. Acute kidney failure can be associated with chest pain, decrease in urine output, fluid retention that leads to swelling in ankles, feet, and legs, fatigue, drowsiness, weakness in muscles, and a shortness of breath. Additionally, a risk of death is also high even for acute kidney failure. For chronic kidney failure, the symptoms are the same, with the addition of nausea, anemia, decreased immunity, high blood pressure, weakness in bones, and for women, complications in pregnancy and health risks to the fetus. Similar to kidney failure, liver failure is also split into acute and chronic (cirrhosis). Symptoms of acute liver failure include nausea, yellowing of the skin and eyes, pain in the upper abdomen, infections in the urinary and respiratory tracts, cerebral edema, and difficulty in regulating blood flow and clotting. For chronic liver failure, symptoms include fatigue, easy bruising, liver cancer, loss of appetite, edema, excessive weakness, and spontaneous bacterial peritonitis (SBP).

Symptoms of lung failure include weakness in muscles, an obstruction to air pathways, and lung diseases such as pneumonia, while symptoms of heart failure include shortness of breath, fatigue, loss of appetite, and an increased heart rate. As for brain failure, there are two classifications-- acute (delirium) and chronic (Alzheimer’s Disease, dementia). While there are major differences among delirium, Alzheimer’s Disease, and dementia, common factors are that memory and focus are impaired, and daily life is also negatively affected.

In addition to the five organ systems mentioned above, there are three other sources of dysfunction that can lead to multiple organ dysfunction syndrome. There is immunologic failure, in which both the specific and nonspecific immune systems function abnormally and/or antibody production is altered. In addition, there is metabolic failure, where a common endocrinologic discrepancy that is easily discovered is insulin resistance. The third one is hematologic failure due to leukocytosis (leukocyte, or white blood cell, count is higher than it should be).

The failure of one organ is already impactful on a patient’s body and the body’s ability to function, and therefore the failure of multiple organs is definitely more impactful and severe. Regardless, there are still steps that can be taken in combating organ failure. For organ dysfunction that is caused by sepsis, the first step is to restore and maintain adequate oxygen delivery to cells. Sepsis generally causes the failure of more than one organ, making it more of a condition to be on the watchout for. While the risk of death associated with multiple organ dysfunction syndrome is still present, organ failure caused by sepsis is generally reversible if the patient survives. Current treatment for sepsis involves limiting the development of organ failure by providing rapid control of any infection and organ support whenever possible.

References:

https://www.medscape.com/answers/169640-99164/what-is-multiple-organ-dysfunction-syndrome-mods

http://www.newhealthguide.org/organ-failure-symptoms.html

https://www.ncbi.nlm.nih.gov/pubmed/26757392

https://www.nature.com/articles/s41581-018-0005-7

Stephanie Chan