Bakker et al used an organ failure score to evaluate patients with septic shock. This can help describe the number and extent of organ failures in the patient. The authors are from Erasme University in Brussels, Belgium.
Organ measures:
(1) respiratory - mechanical ventilation and PaO2/FIO2 ratio
(2) renal - combinations of BUN and/or creatinine
(3) hepatic - bilirubin and transaminases (AST and ALT)
(4) coagulation - platelet count and coagulation factor screening tests (PT and PTT)
|
Parameter |
Findings |
Points |
|---|---|---|
|
mechanical ventilation |
<= 24 hours |
0 |
|
|
> 24 hours |
1 |
|
PaO2 to FIO2 ratio |
>= 250 mm Hg |
0 |
|
|
< 250 mm Hg |
1 |
|
renal function (initially normal) |
BUN < 40 mg/dL and creatinine <= 180 µmol/L |
0 |
|
|
BUN > 80 mg/dL or creatinine > 350 µmol/L |
2 |
|
|
else |
1 |
|
renal function (initially abnormal) |
changes in BUN and creatinine < 1.5 times baseline values |
0 |
|
|
changes in BUN and creatinine 1.5 to 1.99 times baseline values |
1 |
|
|
changes in BUN and creatinine >= 2 times baseline values |
2 |
|
serum total bilirubin in the absence of hemolysis |
<= 34 µmol/L |
0 |
|
|
> 34 µmol/L |
1 |
|
AST and ALT |
AST and ALT <= 80 IU/L |
0 |
|
|
AST or ALT > 80 IU/L |
1 |
|
platelet count |
>= 100,000 per µL |
0 |
|
|
< 100,000 per µL |
1 |
|
PT and PTT |
PT >= 60% and PTT <= 80 seconds |
0 |
|
|
PT < 60% or PTT > 80 seconds |
1 |
where:
• Prothrombin time (PT) appears to be prothrombin activity, where the value is read from the dilution curve of seconds vs percent activity. I will use 1.5 times the upper limit of normal as the decision point for the implementation.
• The upper limits of the reference range for AST and ALT are not given. For several chemistry systems the upper limit is <= 40 IU/L. I will use 2 times the upper limit of normal as the decision point.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the extent of organ dysfunction.
Limitations:
• The methods and references ranges for BUN, creatinine, AST, ALT, PT, PTT and bilirubin were not stated.
Purpose: To evaluate a patient with septic shock for multiple organ failure using the score of Bakker et al.
Specialty: Critical Care, Emergency Medicine, Infectious Diseases
Objective: criteria for diagnosis, severity, prognosis, stage, failure handling and therapy escalation, disease progression
ICD-10: A41.9, R57.2, R65.1,
