Pediatric Multiorgan Dysfunction Syndrome in PICU: Epidemiologic Patterns & Predictors of Mortality

Introduction: Multiorgan dysfunction syndrome (MODS) is a complex phenomenon occurring in critically ill or injured children, leading to high morbidity and mortality. Despite the high burden of pediatric sepsis in low- and middle-income countries, data on MODS epidemiology and mortality predictors in Pakistan remain limited. This study aimed to evaluate its prevalence, outcomes, and prognostic factors in the pediatric intensive care unit (PICU).


Methods: A retrospective observational study of children aged 1 month to < 18 years admitted to the PICU from January 2019 to May 2021. MODS was defined using the International Pediatric Sepsis Consensus Conference criteria. Exclusions included length of stay < 24 hours, preterm infants, congenital heart surgery, readmissions within 2 weeks, and those on home ventilation or dialysis. Data on demographics, organ involvement, PELOD, and PRISM scores were collected. Outcomes included mortality, PICU length of stay, and resource utilization. Stepwise forward logistic regression identified mortality predictors (p < 0.05).


Results: Among 778 PICU admissions screened, 338 (43.4%) met MODS criteria and 250 were enrolled. Mean age was 5.09 ± 5.45 years; infants < 1 year comprised 34% (n=85). Common admitting diagnoses included shock/sepsis (n=73, 29.2%), respiratory (n=62, 24.8%), and CNS disorders (n=45, 18%). Mechanical ventilation was used in 239 (95.6%), epinephrine in 196 (76%), and norepinephrine in 81 (32.4%). Mortality was 55.6% (n=138). Progressive MODS (n=192) had mortality of 61.5%(n=118) vs 37.9%(n=22) in persistent MODS (n=58) (OR: 2.61, 95% CI: 1.35–4.77, p=0.002). Median and mean number of organs involved was 4. Mean PELOD: 23.96 in non-survivors vs 13.34 in survivors (p < 0.001); PRISM III: 20.75 vs 18.70 (p=0.026); VIS: 26.71 vs 9.61 (p=0.01). Shorter hospital stay (p=0.021), higher PELOD (p < 0.001), and VIS (p=0.001) were associated with mortality. Among survivors (n=110), 59 (54%) had new/worsened disability; mean illness duration was 10.16 vs 6.83 in survivors without disability (p=0.035).


Conclusions: MODS remains a high-burden, high-mortality condition in our PICU. Illness severity scores, rather than clinical phenotype alone, were the strongest predictors of mortality.