A Revision to Organ Failure Assessment in Critically Ill Patients

Modern intensive care of critically ill patients is evolving. Nearly 1 in 5 hospitalized patients receive intensive care, and there are new diseases, treatments, and approaches to organ support. Many intensive care unit (ICU) patients develop acute, vital organ failure—a nefarious and unremitting cause of death—and structured measures of vital organ function help to quantify illness severity. These scores were developed almost 50 years ago and were meant to be generic and independent of the cause of multiple organ failure. Now, organ failure scores are still incorporated into contemporary risk prediction models, syndromic criteria like Sepsis-3, and disaster triage tools and are also used to compare ICU populations and outcomes from randomized clinical trials. Organ failure scores are used widely by clinicians, researchers, and quality improvement teams. But how these scores should evolve with changes in modern intensive care is debated.