神经危重症患者循环死亡后潜在器官捐献的预测。
Prediction of potential for organ donation after circulatory death in neurocritical patients.
机构信息
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China; Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China.
出版信息
J Heart Lung Transplant. 2018 Mar;37(3):358-364. doi: 10.1016/j.healun.2017.09.015. Epub 2017 Sep 30.
BACKGROUND
The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors.
METHODS
In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China. The patients were followed until circulatory death after withdrawal of life-sustaining treatment.
RESULTS
The C-DCD-Nomogram performed well in predicting patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment with c-statistics of 0.87, 0.88, 0.86 and 0.95, respectively. The DCD-N score was a poor predictor of death within 30, 60 and 240 minutes, with c-statistics of 0.63, 0.69 and 0.59, respectively, although it was able to predict patient death within 120 minutes, with a c-statistic of 0.73. Neither the University of Wisconsin DCD evaluation tool (UWDCD) nor the United Network for Organ Sharing (UNOS) criteria was able to predict patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment (UWDCD tool: 0.48, 0.45, 0.49 and 0.57; UNOS criteria: 0.50, 0.53, 0.51 and 0.63).
CONCLUSION
The C-DCD-Nomogram is superior to the other 3 tools for predicting death within a limited duration after withdrawal of life-sustaining treatment in Chinese neurocritical patients. Thus, it appears to be a reliable tool identifying potential donors after circulatory death.
背景
心脏死亡后器官捐献的成败在很大程度上取决于功能热缺血时间，而这与停止生命支持治疗与心脏停搏之间的时间密切相关。然而，目前尚缺乏可靠的预测模型。本研究旨在比较中国心脏死亡后器官捐献预测列线图（C-DCD-Nomogram）与其他 3 种工具在潜在供者人群中的表现。
方法
本前瞻性、多中心、观察性研究纳入了中国 219 例连续的神经危重症患者。这些患者在停止生命支持治疗后，一直随访至心脏死亡。
结果
C-DCD-Nomogram 在预测停止生命支持治疗后 30、60、120 和 240 分钟内患者死亡方面表现良好，其受试者工作特征曲线下面积（c-statistic）分别为 0.87、0.88、0.86 和 0.95。DCD-N 评分在预测 30、60 和 240 分钟内死亡方面表现较差，c-statistic 分别为 0.63、0.69 和 0.59，尽管它能够预测 120 分钟内的患者死亡，c-statistic 为 0.73。威斯康星大学器官捐献评估工具（UWDCD）和美国器官共享联合网络（UNOS）标准均无法预测停止生命支持治疗后 30、60、120 和 240 分钟内的患者死亡（UWDCD 工具：0.48、0.45、0.49 和 0.57；UNOS 标准：0.50、0.53、0.51 和 0.63）。
结论
C-DCD-Nomogram 优于其他 3 种工具，能够预测中国神经危重症患者停止生命支持治疗后有限时间内的死亡。因此，它似乎是一种可靠的工具，可用于识别心脏死亡后的潜在供者。
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