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

[Le score logistique de dysfonction organique comme outil de prise de décisions éthiques]

Stephan Ehrmann, MD^*, Emmanuelle Mercier, MD^*, Philippe Bertrand, PhD and Pierre-François Dequin, PhD^*

^* From the Service de réanimation médicale polyvalente, Hôpital Bretonneau, Centre hospitalier universitaire de Tours; and the
Laboratoire de biostatistiques, épidémiologie et informatique médicale, Faculté de médecine de Tours, Tours, France.

Address correspondence to: Dr. Stephan Ehrmann, Service de réanimation médicale polyvalente, Hôpital Bretonneau, Centre hospitalier universitaire de Tours, 37 044 Tours cedex 9, France. Phone: + 33 (0) 6 71 10 33 02; Fax: + 33 (0) 2 47 39 65 36; E-mail: stephanehrmann{at}yahoo.co.uk

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 included. Exclusion criteria were: discharge from the ICU or TL before the 72^nd hr. Ninety-three patients remained for evaluation. The LOD was calculated on the day of admission (LOD1) and between the 72^nd and 96^th hr (LOD4). The LOD = LOD4 – LOD1 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 LOD (0 vs –2; P = 0.0046) than the survivors. After logistic regression, a high LOD 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 LOD 4 cut-off. The NPV was 0.89 for a cut-off of 1.

Conclusion: LOD appears to be a predictor of death in the ICU, independent 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 LOD deserves to be evaluated in a population exhibiting greater severity of disease.

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