Healthcare & Clinical Formulas
Marshall Multiple Organ Dysfunction Score (MODS) & PAR Index
Calculate Marshall’s 6-organ Multiple Organ Dysfunction Score (MODS, 0–24) and Pressure-Adjusted Heart Rate PAR = HR * CVP / MAP without vasopressor-dose confounding.
Why Marshall’s MODS uses PAR = HR * CVP / MAP instead of vasopressor infusion doses!
Whereas SOFA scores cardiovascular failure by catecholamine infusion rates (which vary with clinician titration preferences!), John C. Marshall et al. (Critical Care Medicine, 1995) built the Multiple Organ Dysfunction Score (MODS, 0–24) strictly from objective physiological variables across 6 organ systems (each graded 0–4): Respiratory PaO_2/FiO_2, Renal serum creatinine, Hepatic serum bilirubin, Cardiovascular Pressure-Adjusted Heart Rate PAR = HR * CVP / MAP (<=10.0 = 0, 10.1–15.0 = 1, 15.1–20.0 = 2, 20.1–30.0 = 3, >30.0 = 4), Hematologic platelet count, and Neurologic Glasgow Coma Scale!
Summing all 6 daily worst 0–4 organ grades tracks organ failure progression directly: MODS 0 = <1% ICU mortality, 1–4 = ~1–2%, 5–8 = ~3–5%, 9–12 = ~25% ICU mortality, 13–16 = ~50%, 17–20 = ~75%, and 21–24 = ~100%! Meanwhile, counting organs graded >= 3 flags established multi-system organ failure!
| Composite 6-Organ MODS Total (0–24) | Approximate ICU Mortality Band | Failed Organs (Grade >= 3) |
|---|---|---|
| 1 – 8 Points (Mild-Moderate Dysfunction) | 1% – 5% ICU Mortality | Typically 0–1 Severe Organ |
| 9 – 12 Points (e.g., 2+2+1+3+2+1 = 11 pts) | ~25% ICU Mortality | Multi-Organ Escalation Zone |
| 13 – 16 Points / 17 – 24 Points | ~50% (13–16) to 75–100% (17+) | Refractory Multi-Organ Failure |
Total 6-Organ Marshall MODS Score (0–24)
Verifies every organ grade in B2:B7 lies within [0, 4] and sums total MODS.
=IF(OR(COUNTA(B2:B7) < 6, MIN(B2:B7) < 0, MAX(B2:B7) > 4), "Invalid MODS Organ Grade", SUM(B2:B7))Marshall Cardiovascular Pressure-Adjusted Heart Rate PAR = HR * CVP / MAP
Computes PAR from heart rate B8 (bpm), central venous pressure B9 (mmHg), and mean arterial pressure B10 (mmHg).
=IF(OR(B8 <= 0, B9 < 0, B10 <= 0), "Invalid Hemodynamic Inputs", ROUND(B8 * B9 / B10, 1))Try the example
Use the original values or change them to test your understanding.