Introduction
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The multiple organ dysfunction syndrome (MODS) is a major cause of mortality in ARDS. However, there are few studies evaluating this relationship using new score systems for MODS.

Methods
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All patients in the ICU who met American-European Consensus criteria for ARDS \[[@B1]\] between November 1998 and December 2000 were included in the analysis. Criteria for MODS were those proposed by Marshall *et al* \[[@B2]\]. Age, gender, APACHEII score and outcome were also evaluated. The patients were divided into survivors (SV) and nonsurvivors (NSV). The differences between groups were analyzed with *t*-test, ?^2^ and Mann-Whitney as indicated.

Results
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There were 975 admissions to the ICU, of whom 64 (6.6%) presented ARDS criteria. The mean age was 35 ± 13 years and 54 ± 16 years (*P* \< 0.001), and the APACHEII was 16.4 ± 3.3 and 20 ± 5.2 (*P* = 0.02) in SV and NSV, respectively. General mortality was 79% (*n* = 51), 39% (*n* = 20) in females and 61% (*n* = 31) in males (*P* = 0.066). The results of the MODS in SV and NSV are shown in the Table.

                         Day                                                                                                       
  ---------------- ----- ----------------- --------------- ----------------- ----------------- ----------------- ----------------- -----------------
                   *n*   64                59              49                42                35                33                26
  Total            SV    6.2 ± 2.2^\*\*^   5.6 ± 2.5^\*^   5.8 ± 3^\*^       4.8 ± 2.5^\*^     4.3 ± 2.4^\*^     4.7 ± 3.1^\*^     5.5 ± 3.2^-^
                   NSV   8.5 ± 3           9.3 ± 2.8       9.7 ± 2.8         9.5 ± 2.2         8.6 ± 2.8         9.9 ± 2.5         9.2 ± 3.6
  CNS              SV    0                 0.1 ± 0.5       0                 0                 0                 0                 0
                   NSV   0                 0.2 ± 0.8       0                 0                 0                 0.2 ± 0.9         0
  Cardiovascular   SV    1.2 ± 1.2         1.3 ± 1.2       1.5 ± 1           1 ± 0.7^-^        0.7 ± 1.2^\*\*^   1.5 ± 1.1         1.7 ± 1.2
                   NSV   1.8 ± 1.4         2.1 ± 1.3       2.1 ± 1           1.9 ± 1.2         1.8 ± 1.2         2.2 ± 1.1         1.6 ± 1.3
  Pulmonary        SV    3.3 ± 0.5         2.4 ± 1^-^      2.4 ± 1^-^        2 ± 1.2^-^        2.3 ± 1.2         2.1 ± 1.2         2.3 ± 1.1
                   NSV   3.2 ± 0.7         3.1 ± 0.8       3.1 ± 0.9         2.7 ± 0.9         2.7 ± 1           2.6 ± 0.9         2.4 ± 0.8
  Renal            SV    0.4 ± 0.5         0.5 ± 0.8-      0.4 ± 0.6^\*\*^   0.2 ± 0.4^\*^     0.1 ± 0.4^\*^     0.2 ± 0.4^\*^     0.2 ± 0.6^\*\*^
                   NSV   0.8 ± 0.8         1 ± 0.9         1.1 ± 0.8         1.4 ± 0.9         1.4 ± 0.8         1.6 ± 1           1.4 ± 0.8
  Hematologic      SV    0.8 ± 1.1^-^      1 ± 1.1^-^      1.3 ± 1.4         1.3 ± 1.5         0.8 ± 1.3         0.5 ± 1^-^        0.7 ± 1.4
                   NSV   1.8 ± 1.5         1.9 ± 1.3       2.1 ± 1.5         2.2 ± 1.6         1.6 ± 1.4         1.7 ± 1.4         1.8 ± 1.5
  Hepatic          SV    0.5 ± 0.7         0.3 ± 0.6-      0.2 ± 0.4^\*\*^   0.3 ± 0.6^\*\*^   0.3 ± 0.5         0.4 ± 0.7^\*\*^   0.5 ± 0.9^\*\*^
                   NSV   1 ± 1.1           1.1 ± 1.2       1.3 ± 1.2         1.4 ± 1.3         1.2 ± 1.4         1.4 ± 1.2         2 ± 1.3

^\*^*P* \< 0.001; ^\*\*^*P* \< 0.01; ^-^*P* \< 0.05.

Conclusion
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The severity of MODS measured by a specific score is associated with increased mortality in ARDS. Advanced age, male gender and individual dysfunction of renal and hepatic systems were associated with a poor prognosis.
