The most common cause of death in patients with sepsis is deterioration of the function of multiple organs. This syndrome has been called the multiple organ dysfunction syndrome (MODS). The organs most commonly affected are the lungs, liver, and kidneys.<sup>50 Marshall J.C., Cook D.J., Christou N.V. , e al. Multiple organ dysfunction score: A reliable descriptor of a complex clinical outcome Crit Care Med 1995 ;  23 : 1638  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Clinically, manifestations of MODS include arterial hypoxemia (pulmonary dysfunction), cholestatic jaundice (hepatic dysfunction), and azotemia (renal dysfunction). Although a fatal outcome in patients with sepsis and septic shock is virtually always accompanied by MODS, the histopathology of fatal sepsis is remarkably bland. Histologic sections of liver or kidney tissue from patients dying from sepsis or septic shock occasionally show evidence of focal necrosis or apoptosis (programmed cell death), but massive loss of parenchymal mass is virtually never observed.<sup>41 Hotchkiss R.S., Swanson P.E., Freeman B.D. , e al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction Crit Care Med 1999 ;  27 : 1230  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Thus, the physiologic basis for organ dysfunction in sepsis remains a puzzling problem. Results from the author's laboratory and data obtained by other investigators suggest that one important factor underlying the pathogenesis of MODS may be sepsis-induced alterations in cellular energy metabolism.