Table 1 Organ dysfunction in sepsis
From: Organ dysfunction as a new standard for defining sepsis
Target organ | Pathophysiology | Clinical features | SOFA score indices (other beneficial indices) | Available treatments |
|---|---|---|---|---|
Lung (ARDS) | Vascular hyper-permeability, neutrophil accumulation | Impaired oxygenation | PaO2/FIO2 <400 (bilateral infiltration on CXR) | Mechanical ventilation with low tidal volume and PEEP |
Liver | Disturbed intracellular and extracellular bile salt transport | Jaundice, cholestasis | Serum bilirubin ≥1.2 mg/dl | Not established |
Kidney (AKI) | Tubular epithelial cell injury, dysfunction or adaptive response of tubular epithelial cells | Reduced GFR, reduced urine volume | Serum creatinine ≥1.2 Urine output <500 ml/day | Hemodialysis |
Cardiovascular system | Myocardial depression, impaired intracellular calcium homeostasis, disrupted high energy phosphate production. | Ventricular dilatation, reduced ejection fraction, reduced contractility | Mean arterial pressure <70Â mmHg | Inotropic agents, beta-blocker |
Gastrointestinal tract | Epithelial hyper-permeability, altered microbiome | Mucosal bleeding, paralytic ileus | Not included | Proton pump inhibitor, early enteral nutrition, probiotics, SDD |
Central nervous system (SAE) | Direct cellular damage, mitochondrial and endothelial dysfunction, neurotransmission disturbances, calcium dyshomeostasis | Altered mental status | GCS <15 | Light sedation, early rehabilitation |
Blood coagulation system (DIC) | Intravascular coagulation, microvascular damage, systemic thrombin generation, endothelial injury | Bleeding diathesis, microthrombi and tissue ischemia | Platelets <150 × 103/μl (prolonged prothrombin time, increased FDP) | Antithrombin, recombinant thrombomodulin, concentrated platelet preparation |