The logistic organ dysfunction system - A new way to assess organ dysfunction in the intensive care unit
The logistic organ dysfunction system - A new way to assess organ dysfunction in the intensive care unit
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DOI：
10.1001/jama.276.10.802
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发表时间：
1996-09-11
影响因子：
120.7
通讯作者：
Teres, D
中科院分区：
文献类型：
--
作者：
LeGall, JR;Klar, J;Teres, D
客观。-目的：建立一种客观的方法来评估重症监护病房（ICU）患者在ICU住院第一天的器官功能障碍。生理变量定义了6个器官系统的功能障碍，使用逻辑回归技术确定逻辑器官功能障碍（LOD）评分的严重程度和相对权重，并将LOD评分转换为死亡概率。来自欧洲/北美严重度系统研究的12个国家的137个成人内科/外科ICU共连续收治13152例患者。患者出院时的生命状态。LOD系统确定了6个器官系统的1 - 3个器官功能障碍水平：神经系统、心血管系统、肾脏、肺部、血液系统和肝脏，将1至5个LOD点分配给严重程度水平，所得LOD评分范围为0至22分，开发和验证样本中的模型校准非常好（分别为P=.21和P=.50），模型辨别力也是如此（受试者工作特征曲线下面积分别为0.843和0.850）。LOD系统提供了一个客观的工具，用于评估ICU中器官功能障碍的严重程度，这是进行临床试验的关键组成部分。神经、心血管和肾功能障碍是最严重的器官功能障碍，其次是肺和血液功能障碍，肝功能障碍最不严重。LOD系统考虑了器官系统之间的相对严重程度和器官系统内的严重程度。
Objective.-To develop an objective method for assessing organ dysfunction among intensive care unit (ICU) patients on the first day of the ICU stay.Design and Setting.-Physiological variables defined dysfunction in 6 organ systems, Logistic regression techniques were used to determine severity levels and relative weights for the Logistic Organ Dysfunction (LOD) score and for conversion of the LOD score to a probability of mortality.Patients.-A total of 13152 consecutive admissions to 137 adult medical/surgical ICUs in 12 countries from the European/North American Study of Severity Systems.Outcome Measure.-Patient vital status at hospital discharge.Results.-The LOD System identified from 1 to 3 levels of organ dysfunction for 6 organ systems: neurologic, cardiovascular, renal, pulmonary, hematologic, and hepatic, From 1 to 5 LOD points were assigned to the levels of severity, and the resulting LOD scores ranged from 0 to 22 points, Model calibration was very good in the developmental and validation samples (P=.21 and P=.50, respectively), as was model discrimination (area under the receiver operating characteristic curves of 0.843 and 0.850, respectively).Conclusion.-The LOD System provides an objective tool for assessing severity levels for organ dysfunction in the ICU, a critical component in the conduct of clinical trials. Neurologic, cardiovascular, and renal dysfunction were the most severe organ dysfunctions, followed by pulmonary and hematologic dysfunction, with hepatic dysfunction the least severe. The LOD System takes into account both the relative severity among organ systems and the degree of severity within an organ system.