The modified Logistic Organ Dysfunction System (LODS): A diagnostic and prognostic index for critically-ill cardiac patient.

Introduction: The development of multiple organ dysfunction is one of the leading causes of death in critically-ill cardiac patients. The Logistic Organ Dysfunction System (LODS) can be a useful predictor in the assessment of the clinical outcomes of critically ill patients with possible multiple organ dysfunction, (MOD)

Objectives: 1.) To determine the value of LODS in the sequential evaluation of patients with possible organ dysfunction, 2) To determine the value of LODS as a prognostic maker in patients with possible organ dysfunction

Study Design: Prospective cohort

Methodology: Patients with cardiovascular disease admitted at the intensive care unit of the University of Santo Tomas Hospital for a minimum of 48 hours from April 2002 to August 2002 were investigated. Patient's demographic, physiologic and laboratory parameters were noted. The following parameters of the LODS were calculated and evaluated on admission, 24 hours, 48 hours and upon discharge from the ICU: 1) Glasgow Coma Scale (GCS), 2) pA02, Fi02, 3) heart rate , 4) systolic BP (SBP), 5) BUN, 6) creatinine, 7) urine output, 8) white blood count (WBC), 9) bilirubin, 10) platelet count, 11) prothrombin time. A modified value from the standard LODS were made for HR, SBP, and WBC

Results: A total of 123 patients were included in the study with a mean age of 63.8 years, with male predominance (53 percent). Acute myocardial infarction was the leading cause of admission. The mean LODS of patients who survived (N-89) were 2.42 and 1.5 on admission and on discharge respectively. Patients who expired (N-25) had a mean LODS score of eight on admission with a highest score of 17 were observed. The neurological, renal and pulmonary systems were the most common organ dysfunctions involved. A significant difference between LODS score during admission, 24 hours, 48 hours and upon discharge were noted between patients who survived and expired using the t-test

Conclusion: In critically-ill cardiac patients LODS can be a useful index for patients, LODS sequential evaluation of MOD and to predict their possible clinical outcome. A trend of increasing LODS value is indicative of poor outcome. (Author)