Multiple organ failure in sepsis substantially increases mortality. This study 
examined if there was greater hepatic, pancreatic, splenic, or renal injury in 
mice that would die during sepsis induced by cecal ligation and puncture (CLP) 
compared with that of those that would survive. Mice were stratified into groups 
predicted to die (Die-P) or predicted to live (Live-P) in the first 5 days after 
CLP based on plasma interleukin 6 levels. Groups were sacrificed to harvest 
organs for histology. Separate animals were followed for survival with daily 
blood sampling to examine renal function. No significant histological evidence 
of organ injury was observed in either the Live-P or Die-P mice. Minimal hepatic 
injury occurred as plasma aspartate transaminase demonstrated less than a 2-fold 
increase over normal in both groups. In addition, pancreatic injury was minimal 
as there was also less than a 2-fold increase in plasma amylase levels. In 
contrast, blood urea nitrogen levels were nearly five times higher within 24 h 
in Die-P mice compared with those of mice predicted to live. Mice with blood 
urea nitrogen levels higher than 44 mg/dL had a 17.6 higher relative risk of 
dying (95% confidence interval, 4.5-69.4). Cystatin C, a more specific kidney 
function biomarker, was also elevated at 24 h after CLP. When the cystatin C 
levels were analyzed relative to the hours before death, rather than hours after 
CLP, they were also significantly increased in mice Dead by day 5 compared with 
those Alive after day 5. We conclude that limited liver, pancreas, and spleen 
injury develops during murine CLP-induced sepsis while significant kidney injury 
is present. The renal injury becomes worse closer to death.