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Open Access Highly Accessed Research article

Logistic Organ Dysfunction Score (LODS): A reliable postoperative risk management score also in cardiac surgical patients?

Matthias B Heldwein1, Akmal MA Badreldin1*, Fabian Doerr1, Thomas Lehmann2, Ole Bayer3, Torsten Doenst1 and Khosro Hekmat4

Author Affiliations

1 Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Erlanger Allee 101, 07747 Jena, Germany

2 Institute of Medical Statistics, Computer Sciences and Documentation, Friedrich-Schiller-University of Jena, Bachstrasse 18, 07743 Jena, Germany

3 Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Erlanger Allee 101, 07747 Jena, Germany

4 Department of Cardiothoracic Surgery, University of Cologne Kerpener Straße 62, 50937 Cologne, Germany

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Journal of Cardiothoracic Surgery 2011, 6:110  doi:10.1186/1749-8090-6-110

Published: 16 September 2011

Abstract

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.

          Keywords:
          Logistic scoring system; Cardiac surgery; Mortality prediction