The Logistic Organ Dysfunction System
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
- 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).
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.
Footnotes
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A complete list of members of the ICU Scoring Group was previously published in JAMA (1993;270:2957-2963).
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Reprints: Jean-Roger Le Gall, MD, Service de Réanimation Médicale, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France.
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Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.
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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.
