lods-score

name	lods-score
description	Calculate LODS (Logistic Organ Dysfunction Score) for ICU patients. Use for organ dysfunction assessment across 6 systems with weighted scoring.
tier	validated
category	clinical

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).

6. Known Issue — BUN Threshold: The underlying MIMIC-Code SQL uses a BUN threshold of >= 7.5 mg/dL for renal Score 1. This does not match the original publication (Le Gall 1996, Table 5), which defines the Score 1 cutoff as BUN >= 17 mg/dL (= 6 mmol/L × 2.8). Values between 7.5 and 16.9 mg/dL should receive Score 0. This is likely a unit conversion error and has been flagged for correction upstream.

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.