Clinical presentation
Several characteristics of MODS present clinical paradoxes. First, the organs that fail
are frequently not initially involved as part of the initial disease or illness for which the
patient was admitted to the ICU. Second, a lag period often exists between this initial
insult and the development of systemic organ failure. Third, many people believe that
MODS is a systemic manifestation of infection that complicates the presenting illness.
However, not all patients with clinical sepsis and MODS have documented evidence of
microbiologic infection. There is evidence that infection, and in particular endotoxin,
does not play a critical role in the pathogenesis of MODS [7]. Even in those individuals
with documented infections, early identification and effective treatment of the infection
may not lessen the patient's chances of developing organ system failure that, in this scenario,
frequently leads to MODS and death. By all accounts, however, sepsis is an important
element in the development of the syndrome. Chronic disease and age (in its
extremes) also seem to be involved in the development of MODS perhaps by diminishing
organ reserve which predisposes patients to MODS [9].