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

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 (LODI) and between the 72(nd) and 96(th) hr (LOD4). The Delta 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 Delta LOD (0 vs -2; P = 0.0046) than the survivors. After logistic regression, a high Delta 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 Delta LOD >= 4 cut-off. The NPV was 0.89 for a cut-off of >= 1. Conclusion: Delta 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 Delta LOD deserves to be evaluated in a population exhibiting greater severity of disease.