Case of the Month #56 The Protein Puzzle: A Case of Progressive Multi-Organ Dysfunction

Disease-specific factors

• Type of amyloidosis (AL generally worse than ATTR)
• Degree of organ involvement (number and severity)
• Cardiac staging (based on troponin and NT-proBNP levels)
• Free light chain burden and response to treatment (AL)

ICU-specific factors

• Requirement for mechanical ventilation (associated with poor outcome)
• Vasopressor dependency
• Multi-organ failure
• Bleeding complications
• Infectious complications of immunosuppressive therapy

Prognostic scoring

• Mayo Clinic staging for cardiac involvement
• Revised prognostic staging incorporating free light chains
• Poor prognosis with Stage III/IV cardiac involvement (median survival <6 months)