Evaluation of the logistic organ dysfunction system for the assessment of organ dysfunction and mortality

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Objective

To evaluate the performance of the Logistic Organ Dysfunction (LOD) system for the assessment of morbidity and mortality in multiple organ dysfunction/ failure (MOD/F) in an independent database and to evaluate the use of sequential LOD measurements for the prediction of outcome.

Design

Prospective, multicentric cohort study.

Setting

Thirteen adult medical, surgical, and mixed intensive care units (ICUs) in Austria.

Patients

A total of 2893 consecutive admissions to 13 adult medical/surgical intensive care units (ICUs) in Austria.

Outcome measure

Patient vital status at ICU- and hospital discharge.

Results

Univariate analysis showed that the LOD was able to distinguish between survivors and nonsurvivors (2 vs 6 median score, P<0.05). Within organ systems, higher levels of the severity of organ dysfunction were consistently associated with higher mortality. For the prediction of hospital mortality, the original prognostic LOD model did not perform well in our patients as indicated by the goodness-of-fit statistic (C=37.2, 9 df, P<0.0001). Using multiple logistic regression, we developed a prognostic model (using the LOD of the first ICU day) with a satisfactory fit in our patients. The integration of further measurements during the ICU stay could not increase the accuracy of the prediction.

Conclusions

The LOD system can be used to quantify the baseline severity of organ dysfunction. Moreover, after customization of the predictive equation, the LOD was able to predict hospital mortality in our patients with high precision. It thus provides a combined measure of morbidity and mortality for critically ill patients with MOD/F.