To build a predictive score of progression to brain death within 7 d in acute neurocritical patients, which was used to guide clinical decision-making (palliative treatment or organ donation) of such patients.

From May 2017 to April 2019, acute neurocritical patient admitted in the Department of Neurosurgery and Critical Medicine of the First Affiliated Hospital of Sun Yat-Sen University were prospectively enrolled, the related factor of brain injury in those patients were dynamically record. According to the time of admission, the patients were divided into two parts: training set (from May 2017 to April 2018) and validation set (from May 2018 to April 2019). In the training set, 7 d after the occurrence of severe brain injury (GCS<8) was taken as the grouping factor; the univariate and multivariate analysis were used to screen the factors related to the progression to brain death within 7 d, and the Cox regression was used to build area under curve (AUC) curve; a neurology predictive score was built, and its performance was tested in the validation set.

Two hundred and thirty-one patients were included in the study, 139 patients entered the training set and 92 entered the validation set. In the training set, the univariate and multivariate analysis showed: mechanical ventilation with endotracheal intubation (OR=4.87, 95%CI: 1.36-17.35), light reflex absence (OR=4.86, 95%CI: 1.75-33.92), cough reflex absence (OR=4.43, 95%CI: 1.97-20.21) and midline shift ≥5 mm (OR=3.82, 95%CI: 1.05-12.32) were related with progression to brain death within 7 d. In the validation set, the results are consistent with the training set. A score was built based on those related factors, and the AUC of score was 0.84. Further grading of score, the positive predictive rate (progressing to brain death within 7 d) of 4-6 points was 85.7%, while the negative predictive rate (not progressing to brain death) of 0-3 points was 74.3%.

The neurological score based on brain injury assessment can predict the progression to brain death in acute neurocritical patients, but the results need further external validation.