Canadian Journal of Anesthesia

, Volume 53, Issue 5, pp 518–523 | Cite as

Le score logistique de dysfonction organique comme outil de prise de décisions éthiques

  • Stephan Ehrmann
  • Emmanuelle Mercier
  • Philippe Bertrand
  • Pierre-François Dequin
Neuroanesthesia and Intensive Care

Résumé

Objectif

Vérifier si le changement de score logistique de dysfonction organique (LDO) entre le premier et le quatrième jour à ľunité des soins intensifs (USI) peut être prédicteur ďun décès à ľUSI. Le LDO pourrait alors être utilisé pour aider à prendre des décisions concernant les limites thérapeutiques (LT).

Méthode

Cent cinquante-quatre patients ont participé à ľétude. Les critères ďexclusion étaient : un congé de ľUSI ou une LT survenant avant la 72e h. Quatre-vingt-treize patients sont restés pour ľévaluation. Le LDO a été calculé le jour de ľadmission (LDO1) et entre la 72e et la 96e h (LDO4). Ľindex ΔLDO = LDO4 - LDO1 a été calculé pour les survivants et les non-survivants; la sensibilité, la spécificité, la valeur prédictive positive (VPP) et la valeur prédictive négative (VPN) ont été calculées.

Résultats

Seize patients sont morts à ľUSI, ils présentaient un ΔLDO (0 vs - 2 ; P = 0,0046) plus élevé que les survivants. Après régression logistique, un ΔLDO élevé était associé à un plus grand risque de décès à ľUSI indépendamment de la sévérité initiale de la maladie. La VPP de décès à ľUSI a été de 0,66 pour une limite de ΔLDO ≥ 4. La VPN a été de 0,89 pour une limite ≥ 1.

Conclusion

Le ΔLDO semble être un prédicteur de décès à ľUSI, indépendamment de la sévérité initiale de la maladie. La VPP n’est pas suffisamment élevée pour aider à prendre des décisions de LT individuelles. La VPN peut aider à reconnaître les patients à faible risque de décès. Le ΔLDO doit être évalué dans une population présentant des affections plus sévères.

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

Abstract

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 72nd hr. Ninety-three patients remained for evaluation. The LOD was calculated on the day of admission (LOD1) and between the 72nd and 96th hr (LOD4). The ΔLOD = 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 ΔLOD (0vs -2;P = 0.0046) than the survivors. After logistic regression, a high ΔLOD 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 ΔLOD ≥ 4 cut-off. The NPV was 0.89 for a cut-off of ≥ 1.

Conclusion

ΔLOD 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 ΔLOD deserves to be evaluated in a population exhibiting greater severity of disease.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Stephan Ehrmann
    • 1
  • Emmanuelle Mercier
    • 1
  • Philippe Bertrand
    • 2
  • Pierre-François Dequin
    • 1
  1. 1.Service de réanimation médicale polyvalenteHôpital Bretonneau, Centre hospitalier universitaire de ToursToursFrance
  2. 2.the Laboratoire de biostatistiques, épidémiologie et informatique médicaleFaculté de médecine de ToursToursFrance
  3. 3.Service de réanimation médicale polyvalenteHôpital Bretonneau, Centre hospitalier universitaire de ToursTours cedex 9France

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