This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

A New Way to Assess Organ Dysfunction in the Intensive Care Unit

Jean-Roger Le Gall, MD; Janelle Klar; Stanley Lemeshow, PhD; Fabienne Saulnier, MD; Corinne Alberti, MD; Antonio Artigas, MD; Daniel Teres, MD

JAMA. 1996;276(10):802-810.

Abstract
Objective.
—To develop an objective method for assessing organ dysfunction among intensive care unit (ICU) patients on the first day of the ICU stay.

Design and Setting.
—Physiological variables defined dysfunction in 6 organ systems. Logistic regression techniques were used to determine severity levels and relative weights for the Logistic Organ Dysfunction (LOD) score and for conversion of the LOD score to a probability of mortality.

Patients.
—A total of 13 152 consecutive admissions to 137 adult medical/ surgical ICUs in 12 countries from the European/North American Study of Severity Systems.

Outcome Measure.
—Patient vital status at hospital discharge.

Results.
—The LOD System identified from 1 to 3 levels of organ dysfunction for 6 organ systems: neurologic, cardiovascular, renal, pulmonary, hematologic, and hepatic. From 1 to 5 LOD points were assigned to the levels of severity, and the resulting LOD scores ranged from 0 to 22 points. Model calibration was very good in the developmental and validation samples (P=.21 and P=.50, respectively), as was model discrimination (area under the receiver operating characteristic curves of 0.843 and 0.850, respectively).

Conclusion.
—The LOD System provides an objective tool for assessing severity levels for organ dysfunction in the ICU, a critical component in the conduct of clinical trials. Neurologic, cardiovascular, and renal dysfunction were the most severe organ dysfunctions, followed by pulmonary and hematologic dysfunction, with hepatic dysfunction the least severe. The LOD System takes into account both the relative severity among organ systems and the degree of severity within an organ system.

Author Affiliations
for the ICU Scoring Group

From the Intensive Care Unit, Hôpital Saint-Louis, Paris, France (Drs Le Gall and Alberti); the School of Public Health, University of Massachusetts, Amherst (Ms Klar and Dr Lemeshow); Intensive Care Unit, Hôpital Calmette, Lille, France (Dr Saulnier); Servei de Medicina Intensiva, Consultation Hospitalari Parc Tauli, Sabadell, Spain (Dr Artigas); and the Critical Care Division, Baystate Medical Center, Springfield, Mass, and Tufts University School of Medicine, Boston, Mass (Dr Teres).

Footnotes
A complete list of members of the ICU Scoring Group was previously published in JAMA (1993;270:2957-2963).

Reprints: Jean-Roger Le Gall, MD, Service de Réanimation Médicale, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France.

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, III; Joseph E. Parrillo, MD, Chicago, III; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units
Farfel et al.
Age Ageing 2009;38:515-520.
ABSTRACT | FULL TEXT  

Influence of Gender on the Outcome of Severe Sepsis: A Reappraisal
Adrie et al.
Chest 2007;132:1786-1793.
ABSTRACT | FULL TEXT  

Randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis
Siriwardena et al.
Gut 2007;56:1439-1444.
ABSTRACT | FULL TEXT  

Nonpulmonary Organ Dysfunction and Its Impact on Outcome in Patients With Acute Respiratory Failure
Aggarwal et al.
Chest 2007;132:829-835.
ABSTRACT | FULL TEXT  

Platelet Count Decline: An Early Prognostic Marker in Critically Ill Patients With Prolonged ICU Stays
Moreau et al.
Chest 2007;131:1735-1741.
ABSTRACT | FULL TEXT  

Review of the Acuity Scoring Systems for the Pediatric Intensive Care Unit and Their Use in Quality Improvement
Marcin and Pollack
J Intensive Care Med 2007;22:131-140.
ABSTRACT  

Prognosis of Lung Cancer Patients With Life-Threatening Complications
Soares et al.
Chest 2007;131:840-846.
ABSTRACT | FULL TEXT  

Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score
Adrie et al.
Eur Heart J 2006;27:2840-2845.
ABSTRACT | FULL TEXT  

Erythropoiesis Abnormalities Contribute to Early-Onset Anemia in Patients with Septic Shock
Claessens et al.
Am. J. Respir. Crit. Care Med. 2006;174:51-57.
ABSTRACT | FULL TEXT  

Outcome of Critically Ill Allogeneic Hematopoietic Stem-Cell Transplantation Recipients: A Reappraisal of Indications for Organ Failure Supports
Pene et al.
JCO 2006;24:643-649.
ABSTRACT | FULL TEXT  

Candida Colonization of the Respiratory Tract and Subsequent Pseudomonas Ventilator-Associated Pneumonia
Azoulay et al.
Chest 2006;129:110-117.
ABSTRACT | FULL TEXT  

Predictive perioperative factors for developing severe sepsis after major surgery
Mokart et al.
Br J Anaesth 2005;95:776-781.
ABSTRACT | FULL TEXT  

Impact of Humidification Systems on Ventilator-associated Pneumonia: A Randomized Multicenter Trial
Lacherade et al.
Am. J. Respir. Crit. Care Med. 2005;172:1276-1282.
ABSTRACT | FULL TEXT  

Admission Hyperglycemia and Other Risk Factors as Predictors of Hospital Mortality in a Medical ICU Population
Freire et al.
Chest 2005;128:3109-3116.
ABSTRACT | FULL TEXT  

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity
Rivers et al.
CMAJ 2005;173:1054-1065.
ABSTRACT | FULL TEXT  

Coagulopathy After Successful Cardiopulmonary Resuscitation Following Cardiac Arrest: Implication of the Protein C Anticoagulant Pathway
Adrie et al.
J Am Coll Cardiol 2005;46:21-28.
ABSTRACT | FULL TEXT  

Systemic Inflammatory Response and Progression to Severe Sepsis in Critically Ill Infected Patients
Alberti et al.
Am. J. Respir. Crit. Care Med. 2005;171:461-468.
ABSTRACT | FULL TEXT  

One-year Outcome after Severe Pulmonary Exacerbation in Adults with Cystic Fibrosis
Ellaffi et al.
Am. J. Respir. Crit. Care Med. 2005;171:158-164.
ABSTRACT | FULL TEXT  

Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute renal failure: an independent multicentre, prospective study
Lins et al.
Nephrol Dial Transplant 2004;19:2282-2288.
ABSTRACT | FULL TEXT  

Monocyte Human Leukocyte Antigen-DR Transcriptional Downregulation by Cortisol during Septic Shock
Le Tulzo et al.
Am. J. Respir. Crit. Care Med. 2004;169:1144-1151.
ABSTRACT | FULL TEXT  

Secular Trends in Nosocomial Infections and Mortality Associated With Noninvasive Ventilation in Patients With Exacerbation of COPD and Pulmonary Edema
Girou et al.
JAMA 2003;290:2985-2991.
ABSTRACT | FULL TEXT  

Administration of C1 Inhibitor Reduces Neutrophil Activation in Patients with Sepsis
Zeerleder et al.
CVI 2003;10:529-535.
ABSTRACT | FULL TEXT  

Influence of Systemic Inflammatory Response Syndrome and Sepsis on Outcome of Critically Ill Infected Patients
Alberti et al.
Am. J. Respir. Crit. Care Med. 2003;168:77-84.
ABSTRACT | FULL TEXT  

Injurious Mechanical Ventilation and End-Organ Epithelial Cell Apoptosis and Organ Dysfunction in an Experimental Model of Acute Respiratory Distress Syndrome
Imai et al.
JAMA 2003;289:2104-2112.
ABSTRACT | FULL TEXT  

Defining and Improving Data Quality in Medical Registries: A Literature Review, Case Study, and Generic Framework
Arts et al.
J. Am. Med. Inform. Assoc. 2002;9:600-611.
ABSTRACT | FULL TEXT  

The Significance of Distal Bronchial Samples With Commensals in Ventilator-Associated Pneumonia: Colonizer or Pathogen?
Lambotte et al.
Chest 2002;122:1389-1399.
ABSTRACT | FULL TEXT  

Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock
Annane et al.
JAMA 2002;288:862-871.
ABSTRACT | FULL TEXT  

Successful Cardiopulmonary Resuscitation After Cardiac Arrest as a "Sepsis-Like" Syndrome
Adrie et al.
Circulation 2002;106:562-568.
ABSTRACT | FULL TEXT  

Primary Graft Failure Following Lung Transplantation* : Predictive Factors of Mortality
Thabut et al.
Chest 2002;121:1876-1882.
ABSTRACT | FULL TEXT  

Does Acute Organ Dysfunction Predict Patient-Centered Outcomes?*
Clermont et al.
Chest 2002;121:1963-1971.
ABSTRACT | FULL TEXT  

A Conceptual Framework of Frailty: A Review
Bortz
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2002;57:M283-288.
ABSTRACT | FULL TEXT  

Refining Predictive Models in Critically Ill Patients with Acute Renal Failure
Mehta et al.
J. Am. Soc. Nephrol. 2002;13:1350-1357.
ABSTRACT | FULL TEXT  

Sequential Assessment of Multiple Organ Dysfunction as a Predictor of Outcome
Pettila et al.
JAMA 2002;287:713-714.
FULL TEXT  

High-Dose Antithrombin III in Severe Sepsis: A Randomized Controlled Trial
Warren et al.
JAMA 2001;286:1869-1878.
ABSTRACT | FULL TEXT  

Predicting Mortality in Patients Suffering From Prolonged Critical Illness : An Assessment of Four Severity-of-Illness Measures
Carson and Bach
Chest 2001;120:928-933.
ABSTRACT | FULL TEXT  

Mitochondrial Membrane Potential and Apoptosis Peripheral Blood Monocytes in Severe Human Sepsis
ADRIE et al.
Am. J. Respir. Crit. Care Med. 2001;164:389-395.
ABSTRACT | FULL TEXT  

Exhaled and Nasal Nitric Oxide as a Marker of Pneumonia in Ventilated Patients
ADRIE et al.
Am. J. Respir. Crit. Care Med. 2001;163:1143-1149.
ABSTRACT | FULL TEXT  

Performance of APACHE III Models in an Australian ICU
Cook
Chest 2000;118:1732-1738.
ABSTRACT | FULL TEXT  

Treatment of Acute Hypoxemic Nonhypercapnic Respiratory Insufficiency With Continuous Positive Airway Pressure Delivered by a Face Mask: A Randomized Controlled Trial
Delclaux et al.
JAMA 2000;284:2352-2360.
ABSTRACT | FULL TEXT  

Association of Noninvasive Ventilation With Nosocomial Infections and Survival in Critically Ill Patients
Girou et al.
JAMA 2000;284:2361-2367.
ABSTRACT | FULL TEXT  

The Effect of Glutathione and N-Acetylcysteine on Lipoperoxidative Damage in Patients with Early Septic Shock
ORTOLANI et al.
Am. J. Respir. Crit. Care Med. 2000;161:1907-1911.
ABSTRACT | FULL TEXT  

Predictors of Mortality in Acute Respiratory Distress Syndrome . Focus on the Role of Right Heart Catheterization
VIEILLARD-BARON et al.
Am. J. Respir. Crit. Care Med. 2000;161:1597-1601.
ABSTRACT | FULL TEXT  

Hepatic Hemodynamics and Cell Functions in Human and Experimental Sepsis
Pastor and Suter
Anesth. Analg. 1999;89:344-344.
FULL TEXT