LODS Score Calculation

The Logistic Organ Dysfunction Score (LODS) assesses organ dysfunction across 6 systems with logistic regression-derived weights. It provides mortality prediction based on the first ICU day.

When to Use This Skill

• Multi-organ dysfunction assessment
• Mortality prediction with organ-specific weighting
• Research on organ failure patterns
• Alternative to SOFA for organ dysfunction quantification

Score Components (First 24 Hours)

| System | Variables | Score Range | |--------|-----------|-------------| | Neurologic | GCS | 0-5 | | Cardiovascular | HR, SBP | 0-5 | | Renal | BUN, Creatinine, Urine Output | 0-5 | | Pulmonary | PaO2/FiO2 (ventilated only) | 0-3 | | Hematologic | WBC, Platelets | 0-3 | | Hepatic | PT, Bilirubin | 0-1 |

Total Range: 0-22

Pre-computed Table

SELECT
    subject_id,
    hadm_id,
    stay_id,
    lods,
    neurologic,
    cardiovascular,
    renal,
    pulmonary,
    hematologic,
    hepatic
FROM mimiciv_derived.lods;

Component Scoring Details

Neurologic (GCS)

| GCS | Score | |-----|-------| | <= 5 | 5 | | 6-8 | 3 | | 9-13 | 1 | | 14-15 | 0 |

Cardiovascular

| Condition | Score | |-----------|-------| | HR < 30 OR SBP < 40 | 5 | | SBP < 70 OR SBP >= 270 | 3 | | HR >= 140 OR SBP >= 240 OR SBP < 90 | 1 | | Normal | 0 |

Renal

| Condition | Score | |-----------|-------| | UO < 500 OR BUN >= 56 | 5 | | Cr >= 1.6 OR UO < 750 OR BUN >= 28 OR UO >= 10000 | 3 | | Cr >= 1.2 OR BUN >= 7.5 | 1 | | Normal | 0 |

Pulmonary (Ventilated Patients Only)

| PaO2/FiO2 | Score | |-----------|-------| | < 150 | 3 | | >= 150 | 1 | | Not ventilated | 0 |

Hematologic

| Condition | Score | |-----------|-------| | WBC < 1.0 | 3 | | WBC < 2.5 OR Platelets < 50 OR WBC >= 50 | 1 | | Normal | 0 |

Hepatic

| Condition | Score | |-----------|-------| | Bilirubin >= 2.0 OR PT > 15s OR PT < 3s | 1 | | Normal | 0 |

Critical Implementation Notes

1. Prothrombin Time (PT): The "standard" PT is assumed to be 12 seconds. Abnormal is > 15s (12 + 3) or < 3s (12 * 0.25).

2. Pulmonary Scoring: Only scored for patients on mechanical ventilation or CPAP. Non-ventilated patients get 0.

3. CPAP Detection: Identified from oxygen delivery device documentation containing "cpap" or "bipap mask".

4. GCS < 3: Treated as null (erroneous value or tracheostomy).

5. Missing Data: Missing components are imputed as 0 (normal).

Example: Organ Dysfunction Profile

SELECT
    stay_id,
    lods,
    neurologic,
    cardiovascular,
    renal,
    pulmonary,
    hematologic,
    hepatic,
    CASE WHEN neurologic > 0 THEN 1 ELSE 0 END +
    CASE WHEN cardiovascular > 0 THEN 1 ELSE 0 END +
    CASE WHEN renal > 0 THEN 1 ELSE 0 END +
    CASE WHEN pulmonary > 0 THEN 1 ELSE 0 END +
    CASE WHEN hematologic > 0 THEN 1 ELSE 0 END +
    CASE WHEN hepatic > 0 THEN 1 ELSE 0 END AS n_failing_organs
FROM mimiciv_derived.lods
ORDER BY lods DESC;

Example: Multi-Organ Failure Analysis

-- Patients with >= 3 organ systems failing
SELECT
    l.stay_id,
    l.lods,
    adm.hospital_expire_flag AS mortality
FROM mimiciv_derived.lods l
INNER JOIN mimiciv_icu.icustays ie ON l.stay_id = ie.stay_id
INNER JOIN mimiciv_hosp.admissions adm ON ie.hadm_id = adm.hadm_id
WHERE
    (CASE WHEN neurologic > 0 THEN 1 ELSE 0 END +
     CASE WHEN cardiovascular > 0 THEN 1 ELSE 0 END +
     CASE WHEN renal > 0 THEN 1 ELSE 0 END +
     CASE WHEN pulmonary > 0 THEN 1 ELSE 0 END +
     CASE WHEN hematologic > 0 THEN 1 ELSE 0 END +
     CASE WHEN hepatic > 0 THEN 1 ELSE 0 END) >= 3;

References

• Le Gall JR et al. "The Logistic Organ Dysfunction system: a new way to assess organ dysfunction in the intensive care unit." JAMA. 1996;276(10):802-810.