multiple organ dysfunction syndrome

多臓器機能障害症候群 MODS

WordNet

1. wind instrument whose sound is produced by means of pipes arranged in sets supplied with air from a bellows and controlled from a large complex musical keyboard (同)pipe_organ
2. a fully differentiated structural and functional unit in an animal that is specialized for some particular function
3. a government agency or instrument devoted to the performance of some specific function; "The Census Bureau is an organ of the Commerce Department"
4. a periodical that is published by a special interest group; "the organ of the communist party"
5. (medicine) any disturbance in the functioning of an organ or body part or a disturbance in the functioning of a social group; "erectile dysfunction"; "sexual relationship dysfunction" (同)disfunction
6. having or involving or consisting of more than one part or entity or individual; "multiple birth"; "multiple ownership"; "made multiple copies of the speech"; "his multiple achievements in public life"; "her multiple personalities"; "a pineapple is a multiple fruit"
7. the product of a quantity by an integer; "36 is a multiple of 9"
8. a pattern of symptoms indicative of some disease
9. a complex of concurrent things; "every word has a syndrome of meanings"

PrepTutorEJDIC

1. 『オルガン』,パイプオルガン(pipe organ),リードオルガン(reed organ),電子オルガン(electronic organ),手回しオルガン(barrel organ) / (動植物の)『器官』 / (政党・会社などの)機関誌,機関紙 / 《しばしば複数形で》(行動・実施などの)組織,機関
2. 機能障害,機能不全
3. 多数の部分(要素)から成る,複合の,複式の / 倍数
4. (疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/06 12:31:11」(JST)

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Multiple organ dysfunction syndrome
Classification and external resources
ICD-10	R65.2
ICD-9-CM	995.92
eMedicine	med/3372
MeSH	D009102

Multiple organ dysfunction syndrome (MODS), also known as multiple organ failure (MOF), total organ failure (TOF) or multisystem organ failure (MSOF), is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis.

Although Irwin-Rippe cautions in 2005 that the use of "multiple organ failure" or "multisystem organ failure" should be avoided, both Harrison's (2015) and Cecil's (2012) medical textbooks still use the terms "multi-organ failure" and "multiple organ failure" in several chapters, and do not use "multiple organ dysfunction syndrome" at all.

Definition

Multiple organ dysfunction syndrome is the presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention. It usually involves two or more organ systems.

Cause

The condition usually results from infection, injury (accident, surgery), hypoperfusion and hypermetabolism. The primary cause triggers an uncontrolled inflammatory response. Sepsis is the most common cause in operative and non-operative patients. Sepsis may result in septic shock. In the absence of infection, a sepsis-like disorder is termed systemic inflammatory response syndrome (SIRS). Both SIRS and sepsis could ultimately progress to multiple organ dysfunction syndrome. However, in one-third of the patients no primary focus can be found. Multiple organ dysfunction syndrome is well established as the final stage of a continuum: SIRS + infection sepsis severe sepsis Multiple organ dysfunction syndrome. Currently, investigators are looking into genetic targets for possible gene therapy to prevent the progression to Multiple organ dysfunction syndrome. Some authors have conjectured that the inactivation of the transcription factors NF-κB and AP-1 would be appropriate targets in preventing sepsis and SIRS. These two genes are pro-inflammatory. However, they are essential components of a normal healthy immune response, so there is risk of increasing vulnerability to infection, which can also cause clinical deterioration.

Some have developed a mouse model sepsis via cecal ligation and puncture (CLP). Male Balb/c mice subjected to CLP were given an IL-10-carrying vector or an empty control vector. Lung, Liver and kidney tissue destruction were measured by assessing myeloperoxidase and malonialdehyde activity; these last two are endogenous oxidizing compounds produced during tissue inflammation. The authors assessed the level neutrophil infiltration in lung and liver tissue. IL-10 protein expression was measured using immunohistochemistry. The expression of Tumor necrosis factor-alpha (TNF-α) mRNA was measured at 3, 8 and 24 hours after CLP using reverse transcription polymerase chain reaction. Their results show significantly reduced organ damage by IL-10 gene transfer, as quantified by reduced myeloperoxidase activity in the lung, liver and kidney. The malonialdehyde level was not affected by the transfer into the liver. The livers of the mice infected with the adenoviral vector showed reduced neutrophil activity. The lung and kidney samples in mice carrying the gene showed lower expression of TNF-α mRNA. The investigators concluded that increased IL-10 expression significantly reduced sepsis-induced Multiple organ injury.

Pathophysiology

A definite explanation has not been found. Local and systemic responses are initiated by tissue damage. Respiratory failure is common in the first 72 hours after the original insult. Subsequently, one might see liver failure (5–7 days), gastrointestinal bleeding (10–15 days) and kidney failure (11–17 days).

Gut hypothesis

The most popular hypothesis by Deitch to explain MODS in critically ill patients is the gut hypothesis. Due to splanchnic hypoperfusion and the subsequent mucosal ischaemia there are structural changes and alterations in cellular function. This results in increased gut permeability, changed immune function of the gut and increased translocation of bacteria. Liver dysfunction leads to toxins escaping into the systemic circulation and activating an immune response. This results in tissue injury and organ dysfunction.

Endotoxin macrophage hypothesis

Gram-negative infections in MODS patients are relatively common, hence endotoxins have been advanced as principal mediator in this disorder. It is thought that following the initial event cytokines are produced and released. The pro-inflammatory mediators are: tumor necrosis factor-alpha (TNF-α), interleukin-1, interleukin-6, thromboxane A2, prostacyclin, platelet activating factor, and nitric oxide.

Tissue hypoxia-microvascular hypothesis

As a result of macro- and microvascular changes insufficient supply of oxygen occurs. Hypoxemia causes cell death and organ dysfunction .

Mitochondrial DNA hypothesis

According to findings of Professor Zsolt Balohh and his team at University of Newcastle (Australia), Mitochondrial DNA is the leading cause of severe inflammation due to massive amount of Mitochondrial DNA that leaks into the blood stream due to cell death into the blood stream of patients that survived Major trauma.

Mitochondrial DNA is very similar-looking like bacterial DNA. And if bacteria is triggering leukocytes, maybe the mitochondrial DNA does the same. When confronted with bacteria, white blood cells, or Neutrophil granulocyte, behave like predatory spiders. They spit out a web, or net, to trap the invaders, then hit them with a deadly oxidative blast. Neutrophil extracellular traps (NETs)

This result in catastrophic immune response leading to multiple organ dysfunction syndrome.

Integrated hypothesis

Since in most cases no primary cause is found, the condition could be part of a compromised homeostasis involving the previous mechanisms.

Diagnosis

The European Society of Intensive Care organized a consensus meeting in 1994 to create the "Sepsis-Related Organ Failure Assessment (SOFA)" score to describe and quantitate the degree of organ dysfunction in six organ systems. Using similar physiologic variables the Multiple Organ Dysfunction Score was developed.

Four clinical phases have been suggested:

• Stage 1 the patient has increased volume requirements and mild respiratory alkalosis which is accompanied by oliguria, hyperglycemia and increased insulin requirements.
• Stage 2 the patient is tachypneic, hypocapnic and hypoxemic; develops moderate liver dysfunction and possible hematologic abnormalities.
• Stage 3 the patient develops shock with azotemia and acid-base disturbances; has significant coagulation abnormalities.
• Stage 4 the patient is vasopressor dependent and oliguric or anuric; subsequently develops ischemic colitis and lactic acidosis.

Management

At present there is no agent that can reverse the established organ failure. Therapy therefore is limited to supportive care, i.e. safeguarding hemodynamics, and respiration. Maintaining adequate tissue oxygenation is a principal target. Starting enteral nutrition within 36 hours of admission to an intensive care unit has reduced infectious complications.

Prognosis

Mortality varies from 30% to 100% where the chance of survival is diminished as the number of organs involved increases. Since the 1980s the mortality rate has not changed. In patients with sepsis, septic shock, or multiple organ dysfunction syndrome that is due to major trauma, the rs1800625 polymorphism is a functional single nucleotide polymorphism, a part of the receptor for advanced glycation end products (RAGE) transmembrane receptor gene (of the immunoglobulin superfamily) and confers host susceptibility to sepsis and MODS in these patients.

History

The historical origin of the concept of MODS is as follows. For many years, some patients were loosely classified as having sepsis or the sepsis syndrome. In more recent years, these concepts have been refined – so that there are specific definitions of sepsis – and two new concepts have been developed: the SIRS and MODS.

References

Further reading

• The ICU Book by Marino
• Cecil Textbook of Medicine
• The Oxford Textbook of Medicine
• Harrison's Principles of Internal Medicine

UpToDate Contents

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• 1. 成人における敗血症症候群：疫学、定義、臨床症状、診断および予後 sepsis syndromes in adults epidemiology definitions clinical presentation diagnosis and prognosis
• 2. 敗血症の病態生理 pathophysiology of sepsis
• 3. 小児における全身性炎症反応症候群（SIRS）および敗血症：定義、疫学、臨床症状、および診断 systemic inflammatory response syndrome sirs and sepsis in children definitions epidemiology clinical manifestations and diagnosis
• 4. 成人におけるショックの定義、症状、病因、および病態生理 definition classification etiology and pathophysiology of shock in adults
• 5. 成人における確定診断を得られていない低血圧やショックの評価および初期アプローチ evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock

English Journal

• Effects of chronic γ-irradiation on growth and survival of the Tohoku hynobiid salamander, Hynobius lichenatus.

• Fuma S1, Une Y2, Ihara S3, Matsui K4, Kudo T2, Tokiwa T2, Kubota Y5, Soeda H5, Ishikawa T6, Doi K7, Watanabe Y5, Yoshida S5.
• Journal of environmental radioactivity.J Environ Radioact.2014 Sep;135:84-92. doi: 10.1016/j.jenvrad.2014.04.001. Epub 2014 May 4.
• The Tohoku hynobiid salamanders, Hynobius lichenatus, were chronically irradiated with γ-rays from embryonic to juvenile stages for 450 days. At 490 μGy h(-1) or lower dose rates, growth and survival were not significantly affected by irradiation, and any morphological aberrations and histologic
• PMID 24797100

• [Septic shock in ICU: advanced therapeutics, immunoparalysis and genomics. State of the art].

• Arriagada S D1, Donoso F A1, Cruces R P2, Díaz R F2.
• Archivos argentinos de pediatría.Arch Argent Pediatr.2014 Aug;112(4):358-65. doi: 10.1590/S0325-00752014000400012.
• New and important concepts have emerged for the advanced management of the child with septic shock in the recent decades. Attending physicians in the Pediatric intensive care unit must be fully aware of them to improve patient care in the critical care unit. It should be considered the use of immune
• PMID 24955908

• Epidemiological and bacteriological profiles in children with burns.

• Fekih Hassen A1, Ben Khalifa S2, Daiki M2.
• Burns : journal of the International Society for Burn Injuries.Burns.2014 Aug;40(5):1040-5. doi: 10.1016/j.burns.2013.10.020. Epub 2013 Dec 9.
• OBJECTIVES: The aim of our study is to determine the most prevalent bacteria responsible for nosocomial infection (NI) in burned children.MATERIALS AND METHODS: A prospective analytic study was conducted over a period of 30 months at the Children's Hospital of Tunisia. All burned children were enrol
• PMID 24331406

Japanese Journal

• 予後の予測因子 (特集 ALI/ARDSの診断と治療)

• 遠藤 重厚,高橋 学,松本 尚也 [他]
• 呼吸器内科 25(3), 227-232, 2014-03
• NAID 40020036933

• 感染性多臓器不全の治療 (特集 重症感染症の病態と治療 : 最近の進歩)

• 中村 智之,西田 修
• ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 37(4), 263-271, 2013-04
• NAID 40019688180

• Thrombocytopenia with Reticulin Fibrosis Accompanied by Fever, Anasarca and Hepatosplenomegaly : A Clinical Report of Five Cases

• Takai Kazue,Nikkuni Koji,Momoi Akihito,Nagai Koichi,Igarashi Natsue,Saeki Takako
• Journal of Clinical and Experimental Hematopathology 53(1), 63-68, 2013
• … Two patients needed hemodialysis because of renal dysfunction and oliguria with massive pleural effusion. … Histologically, paracortical hyperplasia with vascular proliferation and atrophic germinal centers resembling hyaline-vascular-type Castleman's disease or POEMS syndrome were detected. … Two patients achieved complete remission, two were steroid-dependent and the remaining one died of multiple organ failure. …
• NAID 130003366789

Related Links

• Multiple organ dysfunction syndrome - definition of Multiple ...

multiple /mul·ti·ple/ (mul´tĭ-p'l) manifold; occurring in or affecting various parts of the body at once. multiple multiple adjective Of or characterised by ... multiple organ dysfunction syndrome (multiple organ failure) failure of two or more ...

• The multiple organ dysfunction syndrome - Surgical Treatment ...

The most common cause of death for patients admitted to a contemporary intensive care unit (ICU) is a clinical condition that owes its existence to the development of the ICU. Variously known as the multiple organ dysfunction ...

Related Pictures

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★リンクテーブル★

リンク元	「多臓器機能障害症候群」「多臓器不全」「多臓器機能不全症候群」「multi-organ disorder」「MODS」
関連記事	「dysfunction」「multiple」「organ」「multiple organ」「syndrome」

「多臓器機能障害症候群」

　　[★]

英

multiple organ dysfunction syndrome MODS, multiple organ dysfunctional syndrome

同

多臓器機能障害、多臓器障害、多臓器損傷、多臓器不全症候群

関

多臓器不全 multiorgan failure

定義

• 2つ以上の主要臓器の機能異常(ICU.642)

多臓器不全の構成要素 ICU.642改

• 敗血症性脳症
• 重症疾患多発神経障害、筋障害
• 急性呼吸窮迫症候群
• 敗血症性ショック
• 上部消化管出血
• イレウス、細菌のトランスロケーション
• 腎障害
• 急性尿細管壊死
• 播種性血管内凝固

「多臓器不全」

　　[★]

英

multiple organ failure MOF

同

多臓器不全症候群、多臓器機能不全症候群 multiple organ dysfunction syndrome MODS　？？？？？？？

• 図：ICU.643
• 肺(ARDS)、腎臓、心血管系、中枢神経系に障害を受けやすい。

「多臓器機能不全症候群」

　　[★]

英

multiple organ dysfunction syndrome

同

MODS

関

多臓器不全

「multi-organ disorder」

　　[★]

多臓器障害

関

MODS、multiple organ dysfunction syndrome

「MODS」

　　[★] 多臓器機能障害症候群 multiple organ dysfunction syndrome

「dysfunction」

　　[★]

• n.

• 機能不全、機能障害、機能異常

• vi

• 機能不全に陥る

関

barrier、damage、difficulty、disorder、disturbance、foe、functional disorder、functional impairment、hindrance、hypofunction、impair、impairment、impediment、incompetence、insufficiency、lesion、malfunction、obstacle、stun

　 　

「multiple」

　　[★]

• n.

• 倍数

• adj.

関

multifocality、multiplex、plural

　 　 　

「organ」

　　[★]

• n.

• 臓器、器官

　 　 　 　 　

「multiple organ」

　　[★]

• 多臓器の

関

multiorgan

「syndrome」

　　[★]

• n.

• 症候群