Predictive value of optic nerve sheath diameter in the risk of death in patients with severe brain injury / 中华急诊医学杂志

ABSTRACT

Objective:To explore the value of ultrasonic measurement of optic nerve sheath diameter (ONSD) in predicting the risk of death in patients with severe brain injury.Methods:This was a prospective observational study based on 84 postoperative patients with severe brain injury from January 2020 to September 2020 in our department. The patients were divided into two groups the survival group and the deceased group. The clinical features between the two groups were compared. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of ONSD, neuron-specific enolase (NSE) and the combination of the two in predicting death in patients with severe brain injury. Binary logistic regression was used to analyze the independent risk factors for death. A prediction model for the risk of death was constructed.Results:There were 61 cases (72.6%) in the survival group and 23 cases (27.4%) in the deceased group. There were significant differences in age, Glasgow coma score (GCS), ONSD and NSE at 12 h after surgery between the two groups. According to the ROC curve, the optimal cutoff levels of ONSD and NSE for predicting death were 5.5 mm and 21.75 ng/mL, respectively. When the two indicators were combined, the area under the curve was 0.897 ( P<0.01). At this threshold, the sensitivity and specificity were 100% and 70.5%, respectively. ONSD ( OR=9.713; 95% CI 1.192-79.147) and GCS scores ( OR=0.492; 95% CI 0.318-0.763) at 12 h after surgery were independent risk factors for death in patients with severe brain injury (both P<0.05). Conclusions:Early postoperative ONSD is an independent risk factor for death in patients with severe brain injury. The combination of ONSD and NSE has the best predictive effect.