Prediction of Evolution Toward Brain Death in Acute Neurocritical Patients Identified as Potential Organ Donors.
Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, Ecuador
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Meeting: 2017 American Transplant Congress
Abstract number: C80
Keywords: Brain death, Prediction models, Prognosis, Radiologic assessment
Session Information
Session Name: Poster Session C: Donor Management: All Organs
Session Type: Poster Session
Date: Monday, May 1, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Objective: Reliable prediction of brain death (BD) is of specific interest for organ donation after brain death(DBD). We sought to establish a score based on neurological factors to predict the probability of evolution toward brain death after spontaneous respiratory arrest
Methods: In this prospective observational study, we collected clinical data of acute neurocritical patients with a potential progression to BD, admitted in our hospital from November 2015 to October 2016. End point was BD comfirmed. The clinical data were compared between patients who identified as BD within 7 days and those who identified beyond 7 days, the time of spontaneous respiratory arrest as start point. Neurological examination, laboratory testing and radiographic data before the BD, were recorded. Univariate and multivariable logistic regression analyses to assess associations between BD within 7 days after spontaneous respiratory arrest and these variables. Points attributed to each variable were summed to create a predictive score for BD in neurocritical patients.
Results: A total of 95 patients satisfied our inclusion criteria. 21 (22.1%) patients identified as BD within 3-5 days, 43 (45.3%) patients identified as BD within 5-7 days, 31 (32.6%) patients identified as BD after 7 days. Multivariable logistic regression analysis showed that absent pupil reflex (OR=6.93, 95%CI 1.59-34.09, P=0.015), cough reflex (OR=6.15, 95%CI 1.31-31.21, P=0.029), absent motor response to pain (OR=15.69, 95%CI 2.94-81.92, P=0.001), absent cisterna ambiens (OR=12.86, 95%CI 1.61-88.76, P=0.018) and midline shift (OR=17.18, 95%CI 3.05-103.73, P=0.007) on brain CT imagine were associated with brain death within 7 days. AUC for the score was 80.6% for prediction of brain death within 7 days. A score of 3-5 was translated into an 81.1% chance (positive predictive value) of brain death within 7 days and a score of 1-2 translated into a 78.9% chance (negative predictive value) of brain death beyond 9 days.
Conclusion:The BD-N score can be used to predict time of brain death after spontaneous respiratory arrest in acute neurocritical patients. However, further prospective validation is needed.
CITATION INFORMATION: Xu G, Xu P, Guo Z, He X. Prediction of Evolution Toward Brain Death in Acute Neurocritical Patients Identified as Potential Organ Donors. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Xu G, Xu P, Guo Z, He X. Prediction of Evolution Toward Brain Death in Acute Neurocritical Patients Identified as Potential Organ Donors. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/prediction-of-evolution-toward-brain-death-in-acute-neurocritical-patients-identified-as-potential-organ-donors/. Accessed May 13, 2025.« Back to 2017 American Transplant Congress