Early identification of potential brain death organ donors based upon prediction of spontaneous respiratory arrest / 中华器官移植杂志

ABSTRACT

Objective:To construct a nomogram model for spontaneous respiratory arrest prediction in nerocritical patients within 72 hours after brain injury for early identification of potential brain death organ donors.Methods:From October 2017 to May 2019, 127 hospitalized neurocritical patients (including traumatic brain injury and spontaneous cerebral hemorrhage) were prospectively enrolled and the parameters related to brain injury were dynamically recorded. Among them, the data from October 1, 2017 to May 31, 2018 were used for constructing the training set and the data from June 1, 2018 to January 31, 2019 for constructing the validation set. The occurrence of spontaneous respiratory arrest within 72 h after brain injury was regarded as the time interest point and grouping factor. The factors associated with spontaneous respiratory arrest were screened by univariate and multivariate analyses. Then the Nomogarm prediction model was developed and tested in the validation set.Results:Sixty-five patients entered the training set and another 62 cases were enrolled into the validation set. In training set, univariate and multivariate analyses indicated that midline shift ( OR=4.56, 95%CI 1.87~19.21), absent of ambient cistern ( OR=4.83, 95%CI 1.35~16.34), cough reflex ( OR=3.82, 95%CI 1.15~12.42), intraventricular hemorrhage ( OR=3.16, 95%CI 1.53~14.52) and serum Na + <125 mmol/L ( OR=3.06, 95%CI 1.53~13.44) were associated with spontaneous respiratory within 72 h. In both sets, the predicted C index of spontaneous respiratory arrest rate within 72 h was 0.81 (95%CI 0.76~0.85) and 0.80 (95%CI 0.75~0.83) respectively. Further statistical analysis implied that 140, 160 and 170 points were the dangerous dividing points and these three points were 30.1%, 65.6% and 93.4% associated with spontaneous respiratory arrest within 72 h respectively. Conclusions:Nomogram model based upon assessment parameters of brain injury may predict the time of spontaneous respiratory arrest in neurocritical patients. It can be used for early identification of potential brain death organ donors. The results require further external data validation.