Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
Department of Neurology, Boston University Medical Center, Boston, MA, United States.
Resuscitation. 2023 Nov;192:109955. doi: 10.1016/j.resuscitation.2023.109955. Epub 2023 Sep 1.
Brain death (BD) occurs in 9-24% of successfully resuscitated out-of-hospital cardiac arrests (OHCA). To predict BD after OHCA, we developed a novel brain death risk (BDR) score.
We identified independent predictors of BD after OHCA in a retrospective, single academic center cohort between 2011 and 2021. The BDR score ranges from 0 to 7 points and includes: non-shockable rhythm (1 point), drug overdose as etiology of arrest (1 point), evidence of grey-white differentiation loss or sulcal effacement on head computed tomography (CT) radiology report within 24 hours of arrest (2 points), Full-Outline-Of-UnResponsiveness (FOUR) score of 0 (2 points), FOUR score 1-5 (1 point), and age <45 years (1 point). We internally validated the BDR score using k-fold cross validation (k = 8) and externally validated the score at an independent academic center. The main outcome was BD.
The development cohort included 362OHCA patients, of whom 18% (N = 58) experienced BD. Internal validation provided an area under the receiving operator characteristic curve (AUC) (95% CI) of 0.931 (0.905-0.957). In the validation cohort, 19.8% (N = 17) experienced BD. The AUC (95% CI) was 0.849 (0.765-0.933). In both cohorts, a BDR score >4 was the optimal cut off (sensitivity 0.903 and 0.882, specificity 0.830 and 0.652, in the development and validation cohorts respectively).
The BDR score identifies those at highest risk for BD after OHCA. Our data suggest that a BDR score >4 is the optimal cut off.
在成功复苏的院外心脏骤停（OHCA）中，脑死亡（BD）的发生率为 9-24%。为了预测 OHCA 后的 BD，我们开发了一种新的脑死亡风险（BDR）评分。
我们在 2011 年至 2021 年期间，在一个回顾性、单一学术中心队列中确定了 OHCA 后发生 BD 的独立预测因素。BDR 评分范围为 0 至 7 分，包括：非可除颤节律（1 分）、药物过量作为停搏病因（1 分）、停搏后 24 小时内头部 CT 影像学报告中出现灰白质分化丧失或脑沟消失证据（2 分）、全面无反应（FOUR）评分 0（2 分）、FOUR 评分 1-5（1 分）和年龄<45 岁（1 分）。我们使用 K 折交叉验证（k=8）对内部分数进行了内部验证，并在一个独立的学术中心对该分数进行了外部验证。主要结局是 BD。
发展队列包括 362 例 OHCA 患者，其中 18%（N=58）发生 BD。内部验证提供了接收者操作特征曲线（AUC）（95%CI）为 0.931（0.905-0.957）。在验证队列中，19.8%（N=17）发生了 BD。AUC（95%CI）为 0.849（0.765-0.933）。在两个队列中，BDR 评分>4 是最佳截断值（在发展和验证队列中的敏感性分别为 0.903 和 0.882，特异性分别为 0.830 和 0.652）。
BDR 评分可识别 OHCA 后发生 BD 的高危人群。我们的数据表明，BDR 评分>4 是最佳截断值。
