The logistic organ dysfunction score as a tool for making ethical decisions.
OBJECTIVE
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 72nd hr. Ninety-three patients remained for evaluation. The LOD was calculated on the day of admission (LOD1) and between the 72nd and 96th hr (LOD4). The DeltaLOD = 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 DeltaLOD (0 vs -2; P = 0.0046) than the survivors. After logistic regression, a high DeltaLOD 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 DeltaLOD > or = 4 cut-off. The NPV was 0.89 for a cut-off of > or = 1.


CONCLUSIONS
DeltaLOD 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 DeltaLOD deserves to be evaluated in a population exhibiting greater severity of disease.
Ehrmann
Stephan
S
Service de réanimation médicale polyvalente, Hôpital Bretonneau, Centre hospitalier universitaire de Tours, 37 044 Tours cedex 9, France. stephanehrmann@yahoo.co.uk
Mercier
Emmanuelle
E
Bertrand
Philippe
P
Dequin
Pierre-François
PF
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000941:ethics*; D016638:Critical Illness / Q000145:classification; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors