Decoding Multiple Organ Dysfunction: Biomarkers, MOD scores and Tableau-Based Analytics Part-1: Understanding Multi-Organ Dysfunction and MOD scores
Updated: Jan 14
Multi-Organ Dysfunction Syndrome (MODS) is a severe, life-threatening condition where two or more organs systems fails due to major illness, injury, or infection (like sepsis) causes widespread inflammation. Organ systems are groups of organs working together to perform essential functions in the body. Failure to function may lead to organ damage without intensive support. MODS can affect any organ in the body. The commonly affected organs includes Lungs. Heart, Brain, Kidneys, Liver and Blood.
As its unpredictable to track its progression, understanding the causes and its symptoms plays a crucial role in providing the right treatment and managing the condition. In this article, we will cover all you need to know about MODS, MOD scores and visualization aiming to provide a clear understanding of distribution of population as per MOD scores in our dataset.
Causes of Multiorgan dysfunction syndrome-
Widespread inflammation, decreased blood flow and organs impair functioning are often responsible for MODS. Any major illness, injury or infection can result in MODS. The most common causes include:
Sepsis or Septic shock: Bacterial or viral infections leading to widespread inflammation. This widespread inflammation can damage tissues and lead to organ failure.
Major trauma and burns: Extensive physical injuries caused due to vehicle accidents, burns, stabbing can result in excessive inflammation, significant blood loss, and a drop in oxygen supply to vital organs, increasing the risk of dysfunction.
Pancreatitis: Inflammation of the pancreas. It is caused due to excessive alcohol consumption, gallstone, medications. Releases harmful enzymes into the blood causing inflammation and damage to organs.
Chronic illnesses: Advanced liver disease, Kidney failure or heart attack makes the body weak reducing its ability to recover from severe infections leading to multiple organ failure.
Toxins and drug reactions: Exposure to poisonous substances, some medications or drug overdoses can directly harm the liver, kidneys, or other organs, leading to dysfunction. Some treatments, such as chemotherapy or prolonged use of strong antibiotics, may also lead to MODS in some patients.
Symptoms and Clinical manifestations of Multiorgan dysfunction syndrome-
MODS can affect any organ in the body and hence its symptoms are specific to the affected organ and its severity. As it progresses multiple organ systems began to fail ultimately leading to life threatening complications too. Some common symptoms include:
Respiratory symptoms: Difficulty in breathing, lower oxygen levels (Hypoxemia), rapid breathing, and respiratory failure requiring ventilatory support.
Cardiovascular symptoms: Low BP, irregular heartbeat, weak pulse, poor circulation and discolored skin.
Kidney symptoms: Low/No urine output (Oliguria or anuria), rising creatinine, swelling in the legs or abdomen due to fluid retention, and electrolyte imbalances.
Liver symptoms: Jaundice (yellowing of the skin and eyes), elevated bilirubin and liver enzymes, abnormal bleeding, and hypoglycemia (in severe liver failure).
Neurological symptoms: Confusion, agitation, drowsiness, or even loss of consciousness due to reduced oxygen and toxin buildup affecting the brain.
Hematologic symptoms: Thrombocytopenia, Coagulopathy, Bleeding or bruising
Nausea, vomiting, bloating, and reduced ability to absorb nutrients, which can lead to weakness and malnutrition.
As MODS progress, the body losses its power to perform vital functions, increasing the risk of organ failure and severe complications.
This clearly indicates MODS is not defined by a single symptom, but by simultaneous dysfunction of ≥2 organ systems with progressive deterioration.
Diagnosing Multi Organ dysfunction Syndrome-
MODS can be diagnosed by thoroughly evaluating organ function, some laboratory tests and imaging studies and scoring system to better understand the cause and severity. Doctors have to rely on a combination of clinical assessments and diagnostic tools since MODS does not affect a single organ rather multiple organs at a time.
Clinical Suspicion-
Clinically ill patients with sepsis or septic shock, major trauma or burns, pancreatitis, breathing, confusion, swelling, or reduced urine output, worsening of vital signs such as heart rate, blood pressure, oxygen levels, and temperature.
Organ System | Clinical Indicators |
Respiratory | Hypoxemia, ↑ ventilator support, PaO₂/FiO₂ ↓ |
Cardiovascular | Hypotension, vasopressor dependence |
Renal | Oliguria, ↑ creatinine |
Hepatic | Jaundice, ↑ bilirubin |
Neurologic | ↓ GCS, delirium |
Hematologic | Thrombocytopenia, coagulopathy |
Table: Organ specific clinical assessment (Diagnosis requires evidence of dysfunction in ≥2 organ systems)
Laboratory and Biomarker Evaluation-
i) ABG test- Arterial blood gas measures the oxygen and carbon dioxide levels in the blood to check lung functioning (PaO₂, PaCO₂).
ii) Kidney function tests- High Serum Creatinine and Blood Urea Nitrogen (BUN) levels, Urine tests.
iii) Liver function tests- Elevated levels of bilirubin, ALT,AST.
iv) Complete Blood count (CBC) tests- white blood cell count and platelet counts.
v) Heart tests- Troponin, serum lactate, lipid profile, cholesterol levels, triglycerides, procalcitonin and
C-reactive protein (CRP)
Imaging Study-
Chest X-ray, CT scan or MRI and Ultrasound- helps identify infections, structural damage to organs, clots, assess blood flow, organ swelling, and dysfunction.
Scoring systems-
i) Sequential Organ Failure Assessment (SOFA) score: Evaluates the dysfunction in multiple organs over time.
ii) APACHE- ICU mortality risk
iii) Multiple Organ Dysfunction Score: Helps determine the chances of recovery based on the number of organs affected across six organ systems (respiratory, hematologic, hepatic, cardiovascular, renal, neurologic) to predict mortality, with higher scores indicating greater dysfunction (0-4 per system (MODS is typically diagnosed when MOD score ≥ 2 in two or more organ systems).
Table: The multiple organ dysfunction (MOD) score (https://pbrainmd.wordpress.com/2015/06/09/multiple-organ-dysfunction-score-mods/)
To briefly understand MOD scores for organ systems we will use the Dataset1.csv that contains Clinical Data. Load the dataset into Tableau (Public/Desktop). We created the calculated fields to determine the MOD scores for respiratory, Renal, Hepatic, Cardiovascular and Hematologic organs systems.
Calculated fields for MOD scores as per organ system:
Respiratory- the process of tissue repair, initiated with the influx of inflammatory cells into the injured lungs, results in fibrosis and hyaline membrane formation, the cardinal pathologic features of late ARDS.
Renal- Renal dysfunction in MODS is reflected in impairment of normal selective excretory function. Creatinine level rises hence derangement of fluids and electrolytes leading to dialysis.
Hepatic- Hepatic dysfunction in MODS is reflected in hyperbilirubinemia and cholestasis.
Cardiovascular- We have used a measure called the pressure-adjusted heart rate (PAHR) to quantify cardiovascular dysfunction in the MOD score. Calculated as the product of the heart rate to mean arterial pressure (HR/MAP); increasing values reflect worsening cardiovascular dysfunction.
Hematologic- Hematologic component of multiple organ dysfunction (MOD) score is determined by its platelets count. The score helps determine the severity of organ dysfunction in critically ill patients. Higher scores indicate greater dysfunction and higher mortality risk.
We calculated the total MOD score based on above organ specific MOD scores.
Classified the severity of dysfunction based on total MOD score into No dysfunction, Mild MOD, Moderate MOD and severe MOD. We tried to analyze our data to see the patients distribution in our dataset as per the severity. We tried to show our analysis by plotting a box-and-whisker style chart as shown below.
Image: Distribution of MOD population based on severity (credit: Author)
Key Insights-
A wide spread in organ dysfunction severity among patients in our dataset.
The average MOD score is around 5, marked by the dashed horizontal line. This suggests that, on an average, patients fall into the moderate organ dysfunction range.
Severe MOD has the highest count overall (≈23,127), highlighting a substantial burden of severe cases in the dataset. Moderate MOD has the largest concentration of cases (≈8,176), making it the most common category.
The upper whisker extending toward Severe MOD indicates a significant subset of patients with high clinical risk.
The dataset is skewed toward moderate-to-severe organ dysfunction, which may imply:
-A critically ill patient population
-Higher expected mortality risk
-Greater demand for intensive care resources
Overall we can say there is High Prevalence of Moderate–Severe Multi-Organ Dysfunction in our dataset.
Conclusion-
Scoring systems which are used to help define organ dysfunction may also be used to help predict mortality and can be sequentially monitored to provide prognostic information. In essence, the MOD score is a robust and widely-used tool that provides valuable, data-driven insight into a patient's condition and likely outcome based on the severity of their multi-organ dysfunction.
MODS is a progressive, life-threatening condition. If not detected early and treated timely the body is unable to maintain homeostasis leading to the failure of two or more organ systems. Its development is associated with high risk mortality, which increases significantly with the number of organs affected.
In the next article (Part-2) we will understand how abnormal range of biomarkers can lead to organ disfunction. Show visualization supported by tableau calculations in regards to our dataset. Overall analysis will determine which organs in our dataset has majority of multi-organ disfunction population.
Thanks for reading and keep learning!
