Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients.

Bo Lv,Yufan Liang,Jia Deng,Jing Xu,Yating Hou,Dayong Sun,Heng Fang,Linhui Hu,Chunbo Chen,Linling He,Huidan Zhang

doi:10.3389/fmed.2021.765818

Abstract

Backgrounds: The plasma colloid osmotic pressure (COP) values for predicting mortality are not well-estimated. A user-friendly nomogram could predict mortality by incorporating clinical factors and scoring systems to facilitate physicians modify decision-making when caring for patients with serious neurological conditions.Methods: Patients were prospectively recruited from March 2017 to September 2018 from a tertiary hospital to establish the development cohort for the internal test of the nomogram, while patients recruited from October 2018 to June 2019 from another tertiary hospital prospectively constituted the validation cohort for the external validation of the nomogram. A multivariate logistic regression analysis was performed in the development cohort using a backward stepwise method to determine the best-fit model for the nomogram. The nomogram was subsequently validated in an independent external validation cohort for discrimination and calibration. A decision-curve analysis was also performed to evaluate the net benefit of the insertion decision using the nomogram.Results: A total of 280 patients were enrolled in the development cohort, of whom 42 (15.0%) died, whereas 237 patients were enrolled in the validation cohort, of which 43 (18.1%) died. COP, neurological pathogenesis and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were predictors in the prediction nomogram. The derived cohort demonstrated good discriminative ability, and the area under the receiver operating characteristic curve (AUC) was 0.895 [95% confidence interval (CI), 0.840–0.951], showing good correction ability. The application of this nomogram to the validation cohort also provided good discrimination, with an AUC of 0.934 (95% CI, 0.892–0.976) and good calibration. The decision-curve analysis of this nomogram showed a better net benefit.Conclusions : A prediction nomogram incorporating COP, neurological pathogenesis and APACHE II score could be convenient in predicting mortality for critically ill neurological patients.

Highlights

Cerebral oedema in patients with critical neurological status may be caused by multiple pathological mechanisms associated with primary and secondary injury patterns
A prediction nomogram incorporating colloid osmotic pressure (COP), neurological pathogenesis and APACHE Simplified Acute Physiology Score II (II) score could be convenient in predicting mortality for critically ill neurological patients
COP, neurological pathogenesis and APACHE II score were recognized as independent predictors in the multivariate logistic regression analysis (Table 2)

Summary

Introduction

Cerebral oedema in patients with critical neurological status may be caused by multiple pathological mechanisms associated with primary and secondary injury patterns. As the internal pressure in the skull increases, intracranial hypertension can cause brain tissues to shift, leading to disability or death [1,2,3,4]. Owing to the importance of intracranial pressure (ICP) monitoring in the care of patients with critical neurological status and its relationship with overall prognosis, ICP monitoring is included in many guidelines for treating brain injury [5,6,7,8]. ICP monitoring is limited by the invasive nature of specific techniques and the high risk–benefit ratios used in certain patient populations [9]. It is meaningful to explore the use of existing biomarkers to detect the prognosis and overall situation of patients with craniocerebral injury

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