How this timeline is built
Each organ gets 0–4 points from the Sequential Organ Failure Assessment cut-points published by Vincent and colleagues in 1996. Urine is entered as mL/h and compared with the daily cut-points of 500 and 200 mL.
- Respiratory: PaO2/FiO2 under 400, 300, 200, and 100. Scores 3 and 4 need ventilatory support.
- Coagulation: platelets under 150, 100, 50, and 20 ×10³/µL. INR is not part of that score.
- Liver: bilirubin 1.2, 2.0, 6.0, and 12 mg/dL.
- Cardiovascular: MAP under 70; dobutamine; norepinephrine at or below 0.1 mcg/kg/min; norepinephrine above 0.1.
- Neurologic: GCS 13–14, 10–12, 6–9, and under 6.
- Renal: creatinine 1.2, 2.0, 3.5, and 5.0 mg/dL, or low urine output. Renal replacement scores 4.
Couplings are fixed edges between organs: shock into the kidney and the liver, liver failure into clotting and alertness, a low neurologic score into the airway. An edge strengthens when the source score is high or rising, and when lactate, blood pressure, pH, ventilation, INR, or a medication tag matches that physiology.
The projection asks one question: if those couplings stay as they are at the selected hour, when does a downstream score reach its next band? It does not learn from a patient database, does not estimate mortality, and does not recommend treatment. Later hours on the track stay hidden until you move forward.
Medication tags are exposure flags, not orders. Sedation weakens the neurologic score as a source. A nephrotoxin or hepatotoxin raises susceptibility. Renal replacement keeps the renal score at 4 and reduces the volume-overload coupling into the lung.