title: Predictive factors of brain death in severe stroke patients identified by organ procurement and transplant coordination in Lorrain, France.
abstract: There are no established predictive factors to identify patients at the acute phase of severe stroke with a high probability of presenting brain death (BD). We retrospectively collected clinical and paraclinical data of consecutive patients at the acute phase of severe stroke with a potential progression to BD through the hospital organ procurement and transplant coordination system in five centres in Lorrain (France) between 1 January 2012 and 31 December 2013. Final endpoint was adjudicated BD. Of 400 included patients, 91 (23%) presented adjudicated BD. Initial Glasgow Coma Scale score ≤6 (P = 0.008), herniation (P = 0.009), hydrocephalus (P = 0.019), initial systolic blood pressure >150 mmHg (P = 0.002), past history of alcohol abuse (P = 0.019) and stroke volume >65 ml (P = 0.040) were significantly associated with BD progression. Two prognostic scores for stroke with unquantifiable or quantifiable volume were built according to the number of risk factors presented. Following internal validation, the respective bias-corrected predictive performance (c-index) of the two scores was 72% (95% confidence interval: 67-78%) and 77% (95% confidence interval: 72-82%). These scores could form the basis of a simple tool of six criteria to help physicians make the difficult decision of intensive care unit management to preserve organs in potential donors.
authors.affiliation: Department of Neurology, Stroke Unit, CHU Nancy, Nancy Cedex, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Humbertjean
authors.affiliation: Department of Neurology, Stroke Unit, CHU Nancy, Nancy Cedex, France.
authors.forename: Gioia
authors.initials: G
authors.lastname: Mione
authors.affiliation: Department of Neurology, Stroke Unit, CHU Nancy, Nancy Cedex, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Fay
authors.affiliation: Agence de la biomédecine, Direction Prélèvement Greffe organes - tissus, SRA Nord-Est, Nancy Cedex, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Durin
authors.affiliation: Department of Neuroradiology, CHU Nancy, Nancy Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Planel
authors.affiliation: Department of Neurology, Stroke Unit, CHU Nancy, Nancy Cedex, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lacour
authors.affiliation: Department of Neurology, Stroke Unit, CHU Nancy, Nancy Cedex, France.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Enea
authors.affiliation: Department of Neurology, Stroke Unit, CHU Nancy, Nancy Cedex, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Richard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke; D009927:Tissue and Organ Procurement; D055815:Young Adult
keywords: brain death; organ donation; organ transplantation; predictive score; severe stroke; stroke volume