RESUMO
INTRODUCTION: The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD. MATERIALS AND METHODS: This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447). The independent predictor factors of death and BD were studied using logistic regression analysis. A hierarchical model consisting of 2 nested logit regression models was then created. With these models, the probabilities of death, BD, and death by cardiorespiratory arrest were analyzed. RESULTS: In the first regression, we observed that as the GCS decreased and age increased, the probability of death rose. Each additional year of age increased the probability of death by 0.014. In the second model, however, BD risk decreased with each year of age. The presence of swelling, mass effect, and/or space-occupying lesion increased BD risk for the same given GCS. In the presence of injuries compatible with intracranial hypertension, age behaved as a protective factor that reduced the probability of BD. CONCLUSIONS: Based on the analysis of the local epidemiology, a model to predict the probability of death and BD can be developed. The organ potential donation of a country, region, or hospital can be predicted on the basis of this model, customizing it to each specific situation.
Assuntos
Morte Encefálica/diagnóstico , Lesões Encefálicas/mortalidade , Técnicas de Apoio para a Decisão , Adulto , Idoso , Feminino , Escala de Coma de Glasgow , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Obtenção de Tecidos e Órgãos , Uruguai/epidemiologiaRESUMO
The National Kidney Transplant Program with cadaveric donors is based on centralized and unique waitlist, serum bank, and allocation criteria, approved by Instituto Nacional de Donación y Trasplante (INDT) in agreement with clinical teams. The median donor rates over last 3 years is 20 per million population and the median number of waitlist candidates is 450. The increased number of waiting list patients and the rapid aging of our populations demanded strategies for donor acceptance, candidate assignment, and analysis of more efficient and equitable allocation models. The objectives of the new national allocation system were to improve posttransplant patient and graft survivals, allow equal access to transplantation, and reduce waitlist times. The objective of this study was to analyze variables in our current allocation system and to create a mathematical/simulation model to evaluate a new allocation system. We compared candidates and transplanted patients for gender, age, ABO blood group, human leukocyte agents (HLA), percentage of reactive antibodies (PRA), and waiting list and dialysis times. Only 2 factors showed differences: highly sensitized and patients >65 years old (Bernoulli test). An agreement between INDT and Engineering Faculty yielded a major field of study. During 2008 the data analysis and model building began. The waiting list data of the last decade of donors and transplants were processed to develop a virtual model. We used inputs of candidates and donors, with outputs and structure of the simulation system to evaluate the proposed changes. Currently, the INDT and the Mathematics and Statistics Institute are working to develop a simulation model, that is able to analyze our new national allocation system.