The logistic organ dysfunction score as a tool for making ethical decisions

Abstract

Purpose: We examined whether the change of the logistic organ dysfunction score (LOD) between the first and the fourth day in the intensive care unit (ICU) could be predictive of death in the ICU. The LOD could then be used to help make decisions concerning therapeutic limitations (TL). Methods: One hundred fifty-four patients were include d. Exclusion criteria were: discharge from the ICU or TL before the 72nd hr. Ninety-three patients remained for evaluation. The LOD was calculated on the day of admission (LODI) and between the 72nd and 96th hr (LOD4). The ΔLOD = LOD4 - LODI index was calculated for survivors and non-survivors; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Sixteen patients died in the ICU, they had a higher ΔLOD (0 vs -2; P = 0.0046) than the survivors. After logistic regression, a high ΔLOD was associated with a higher risk of death in the ICU independent of the initial severity of disease. The PPV concerning death in the ICU was 0.66 for a ΔLOD ≥ 4 cut-off. The NPV was 0.89 for a cut-off of ≥ 1. Conclusion: ΔLOD appears to be a predictor of death in the ICU, ind ependent of the initial severity of disease. The PPV is not high enough to assist with making individual TL decisions. The NPV can help to identify patients at low risk of death. The ΔLOD deserves to be evaluated in a population exhibiting greater severity of disease.