Prediction of brain death in patients with severe traumatic brain injury

Objective. To study the prognostic power of individual clinical and diagnostic features and serum iron levels in patients with severe traumatic brain injury (TBI) in terms of possible brain death.

Materials and methods. A total of 107 patients with severe TBI who underwent intensive care in the anaesthesiology and resuscitation departments of Mogilev region were included in the prospective non-randomized study. Two groups of patients were formed: group 1 (n=56) – patients with a positive treatment outcome, group 2 (n=51) – patients who were diagnosed with brain death.

Results. The level of consciousness according to the Glasgow Coma Scale (GCS) upon admission in group 1 was 12 (8; 14) points, in group 2 – 5 (4; 6) points, p<0.0001. GCS was a good predictor of the onset of brain death (AUC 0.895, p<0.0001). The severity of organ dysfunction assessment (SOFA) score in group 1 was 3 (1; 6) points, in group 2 – 7.5 (6; 11) points, p<0.0001 (AUC 0.821, p<0.0001). The volume of intracranial hematoma on CT upon admission was 76 (56; 107) ml in group 1, 150 (75; 185) ml in group 2, p=0.006 (AUC 0.706, p=0.01). The displacement of the midline structures of the brain in group 1 was 5 (3; 9) mm, in group 2 – 13.5 (4; 17) mm, p=0.025 (AUC 0.690, p=0.042). The level of serum iron (from day 1 to day 10) in group 1 was 6.4 (3.3; 11.5) μmol/l, in group 2 – 3.2 (2; 4.9) μmol/l, p<0.0001 (AUC 0.721, p<0.0001).

Conclusion. A comprehensive analysis of quantitative indicators of head CT data, number of points according to the GCS and SOFA scale, as well as the level of serum iron allows us to predict the onset of brain death in patients with severe TBI.

1. Rummo OO. 7 Years of liver transplantation in the Republic of Belarus. Russian Journal of Transplantology and Artificial Organs. 2015;17(2):100-104. (In Russ.). DOI: https://doi.org/10.15825/1995-1191-2015-2-100-104

2. Pikirenia I, Pirov B, Korotkov S, Kalachik O, Dzyadzko A, Rummo O. Formation and development of organ transplatation in Belarus. Surgery. Eastern Europe. 2016;18(2):258-266. (In Russ.).

3. Khmara VV, et al. Determination of brain death: educational method. allowance. Minsk: Alpha-book; 2022. 80 p. (In Russ.).

4. Gunst J, Souter MJ. Management of the brain-dead donor in the intensive care unit. Intensive Care Med. 2024 Jun;50(6):964-967. DOI: https://doi.org/10.1007/s00134-024-07409-4

5. Anwar ASMT, Lee JM. Medical Management of Brain-Dead Organ Donors. Acute Crit Care. 2019 Feb;34(1):14-29. DOI: https://doi.org/10.4266/acc.2019.00430

6. Lipnitsky AL, Marochka AV. Dynamics of indicators of systemic inflammatory response in patients with brain death. Health and Ecology Issues. 2024;21(4):53-59. (In Russ.). DOI: https://doi.org/10.51523/2708-6011.2024-21-4-06

7. Belatar B, Elabidi A, Barkiyou M, El Faroudi M, Eljaoudi R, Lahlou L, et al. The Influence of Heavy Metals and Trace Elements on Comatose Patients with Severe Traumatic Brain Injury in the First Week of Admission. J Toxicol. 2018 Sep 17;2018:7252606. DOI: https://doi.org/10.1155/2018/7252606

8. Markevich DP, Marochkov AV, Livinskaya VA. Dynamics of the content of water-electrolytic exchange in patients with craniocerebral injury during the perioperative period. Journal of the Grodno State Medical University. 2020;18(5):575-583. (In Russ.). DOI: https://doi.org/10.25298/2221-8785-2020-18-5-575-583

9. On approval of the instruction on the procedure for organizing the provision of medical care to patients with traumatic brain injury: order of the Ministry of Health of the Republic of Belarus dated September 24, 2012 N. 1110. (In Russ.).

10. On approval of the Instruction on the procedure for certifying death and recognizing as invalid the Resolution of the Ministry of Health of the Republic of Belarus dated 2.07.2002 N. 47: Resolution of the Ministry of Health of the Republic of Belarus dated 20.12.2008 N. 228. (In Russ.).

11. Schoene D, Freigang N, Trabitzsch A, Pleul K, Kaiser DPO, Roessler M, et al. Identification of patients at high risk for brain death using an automated digital screening tool: a prospective diagnostic accuracy study. J Neurol. 2023 Dec;270(12):5935-5944. DOI: https://doi.org/10.1007/s00415-023-11938-1

12. Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, et al. Clinico-radiological related to early brain death factors. Med Intensiva (Engl Ed). 2022 Jan;46(1):1-7. DOI: https://doi.org/10.1016/j.medine.2021.11.005

13. Ramtinfar S, Yousefzadeh Sh. Predicting the Destiny after Severe Traumatic Brain Injury; Multi Organ Dysfunction Syndrome (MODS) or Sequential Organ Failure Assessment (SOFA)? Journal of Neurology & Neurophysiology. 2016;7(6):408. DOI: https://doi.org/10.4172/2155-9562.1000408

14. Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, et al. Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006 Apr 25;66(8):1175-1181. DOI: https://doi.org/10.1212/01.wnl.0000208408.98482.99

15. Ward RJ, Zucca FA, Duyn JH, Crichton RR, Zecca L. The role of iron in brain ageing and neurodegenerative disorders. Lancet Neurol. 2014 Oct;13(10):1045-60. DOI: https://doi.org/10.1016/S1474-4422(14)70117-6

16. Yang G, Hu R, Zhang C, Qian C, Luo QQ, Yung WH et al. A combination of serum iron, ferritin and transferrin predicts outcome in patients with intracerebral hemorrhage. Scientific Reports. 2016 Feb 22;6:21970. DOI: https://doi.org/10.1038/srep21970