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Logistic Organ Dysfunction Score (LODS): a reliable postoperative risk management score also in cardiac surgical
Matthias B Heldwein1, Akmal M A Badreldin, Fabian Doerr
1Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Erlanger Allee 101, 07747 Jena, Germany.
Insights
The Logistic Organ Dysfunction Score (LODS) shows reasonable accuracy in predicting intensive care unit (ICU) mortality for cardiac surgery patients, despite not being originally designed for them. Daily LODS measurements improve prediction accuracy during the ICU stay.
Area of Science:
- Critical Care Medicine
- Surgical Outcomes Research
- Health Informatics
Background:
- The original Logistic Organ Dysfunction Score (LODS) was not designed for or validated in cardiac surgery patients.
- The applicability and accuracy of the LODS in this specific patient population remain untested.
- The LODS is noted to not be a true logistic scoring system due to its lack of beta-coefficients.
Purpose of the Study:
- To evaluate the accuracy of the Logistic Organ Dysfunction Score (LODS) in predicting intensive care unit (ICU) mortality in adult patients following cardiac surgery.
- To assess the utility of daily LODS measurements for improving mortality prediction during the ICU stay.
- To determine the calibration and discrimination performance of the LODS in this patient cohort.
Main Methods:
- A prospective study included 2801 adult patients admitted to the ICU after cardiac surgery (January 2007-December 2008).
- The LODS was calculated daily from postoperative day 1 to day 7.
- Performance was assessed using the Hosmer-Lemeshow goodness-of-fit test (calibration) and receiver operating characteristic (ROC) curves (discrimination), with ICU mortality as the outcome measure.
Main Results:
- The overall ICU mortality rate was 5.2%.
- The LODS demonstrated good calibration, with no significant differences between expected and observed mortality rates across all measured days (p ≥ 0.05).
- The area under the ROC curve (AUC) for initial LODS was 0.81, peaking at 0.93 on ICU day 3 and remaining strong at 0.85 by ICU day 7.
Conclusions:
- The Logistic Organ Dysfunction Score (LODS) demonstrates reasonable accuracy in predicting ICU mortality for patients after cardiac surgery, despite prior exclusion from its target population.
- Daily assessment of the LODS in the ICU setting enhances its predictive capability over time.
- The LODS serves as a valuable tool for monitoring and predicting outcomes in critically ill cardiac surgery patients.
Background:
The original Logistic Organ Dysfunction Sore (LODS) excluded cardiac surgery patients from its target population, and the suitability of this score in cardiac surgery patients has never been tested. We evaluated the accuracy of the LODS and the usefulness of its daily measurement in cardiac surgery patients. The LODS is not a true logistic scoring system, since it does not use β-coefficients.
Methods:
This prospective study included all consecutive adult patients who were admitted to the intensive care unit (ICU) after cardiac surgery between January 2007 and December 2008. The LODS was calculated daily from the first until the seventh postoperative day. Performance was assessed with Hosmer-Lemeshow (HL) goodness-of-fit test (calibration) and receiver operating characteristic (ROC) curves (discrimination) from ICU admission day until day 7. The outcome measure was ICU mortality.
Results:
A total of 2801 patients (29.6% female) with a mean age of 66.4 ± 10.7 years were included. The ICU mortality rate was 5.2% (n = 147). The mean stay on the ICU was 4.3 ± 6.8 days. Calibration of the LODS was good with no significant difference between expected and observed mortality rates on any day (p ≥ 0.05). The initial LODS had an area under the ROC curve (AUC) of 0.81. The AUC was best on ICU day 3 with a value of 0.93, and declined to 0.85 on ICU day 7.
Conclusions:
Although the LODS has not previously been validated for cardiac surgery patients it showed reasonable accuracy in prediction of ICU mortality in patients after cardiac surgery.
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