CHARACTERIZATION OF INTENSIVE-CARE UNIT PATIENTS USING A MODEL-BASED ON THE PRESENCE OR ABSENCE OF ORGAN DYSFUNCTIONS AND OR INFECTION - THE ODIN MODEL

Objective: To evaluate the sensitivity, specificity and overall accura cy of a model based on the presence or absence of organ dysfunctions a nd/or infection (ODIN) to predict the outcome for intensive care unit patients. Design: Prospective study. Setting: General intensive care u nit in a university teaching hospital. Patients: 1070 consecutive, uns elected patients. Interventions: There were no interventions. Measurem ents and main results: We recorded within the first 24 h of admission the presence or absence of dysfunction in 6 organ systems: respiratory , cardiovascular, renal, hematologic, hepatic and neurologic, and/or i nfection (ODIN) in all patients admitted to our ICU, thus establishing a profile of organ dysfunctions in each patient. Using univariate ana lysis, a strong correlation was found between the number of ODIN and t he death rate (2.6, 9.7, 16.7, 32.3, 64.9, 75.9, 94.4 and 100% for 0, 1, 2, 3, 4, 5, 6 and 7 ODIN, respectively; (p < 0.001). In addition, t he highest mortality rates were associated with hepatic (60.8%), hemat ologic (58.1%) and renal (54.8%) dysfunctions, and the lowest with res piratory dysfunction (36.5%) and infection (38.3%). For taking into ac count both the number and the type of organ dysfunction, a logistic re gression model was then used to calculate individual probabilities of death that depended upon the statistical weight assigned to each ODIN (in the following order of descending severity: cardiovascular, renal, respiratory, neurologic, hematologic, hepatic dysfunctions and infect ion). The ability of this severity-of-disease classification system to stratify a wide variety of patients prognostically (sensitivity 51.4% , specificity 93.4%, overall accuracy 82.1%) was not different from th at of currently used scoring systems. Conclusions: These findings sugg est that determination of the number and the type of organ dysfunction s and infection offers a clear and reliable method for characterizing ICU patients. Before a widespread use, this model requires to be valid ated in other institutions.