The Logistic Organ Dysfunction System: A New Way to Assess Organ Dysfunction in the Intensive Care Unit

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.