External validation of prediction models for time to death in potential donors after circulatory death

A.M.M. Kotsopoulos, F. Böing-Messing, N.E. Jansen, P. Vos, W.F. Abdo

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot etal (AUC 0.86; 95% CI 0.77-0.95), Wind etal (AUC 0.62; 95% CI 0.49-0.76), Davila etal (AUC 0.80; 95% CI 0.708-0.901) and the Cox regression model by Suntharalingam etal (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.

This study externally validates previous predictive models for time to death in controlled donation after circulatory death donors and identifies that absence of brainstem reflexes, persistent ventilatory failure, and aspects of withdrawal of life-support treatment are predictors for death within 60 minutes.

Original languageEnglish
Pages (from-to)890-896
JournalAmerican Journal of Transplantation
Volume18
Issue number4
DOIs
Publication statusPublished - 2018

Fingerprint

Area Under Curve
Logistic Models
Midazolam
Proportional Hazards Models
Cough
Morphine

Keywords

  • CARDIAC DEATH
  • DONATION
  • END
  • GUIDELINES
  • HEART-TRANSPLANTATION
  • INTENSIVE-CARE UNITS
  • LIFE-SUSTAINING TREATMENT
  • NETHERLANDS
  • ORGAN DONORS
  • WITHDRAWAL
  • clinical research
  • donors and donation
  • donors and donation: donation after circulatory death (DCD)
  • donors and donation: donor evaluation
  • organ transplantation in general
  • practice

Cite this

@article{aaf79b6af1734e43b1aa00763b603f24,
title = "External validation of prediction models for time to death in potential donors after circulatory death",
abstract = "Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60minutes (area under the curve [AUC] 0.89; 95{\%} confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot etal (AUC 0.86; 95{\%} CI 0.77-0.95), Wind etal (AUC 0.62; 95{\%} CI 0.49-0.76), Davila etal (AUC 0.80; 95{\%} CI 0.708-0.901) and the Cox regression model by Suntharalingam etal (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.This study externally validates previous predictive models for time to death in controlled donation after circulatory death donors and identifies that absence of brainstem reflexes, persistent ventilatory failure, and aspects of withdrawal of life-support treatment are predictors for death within 60 minutes.",
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author = "A.M.M. Kotsopoulos and F. B{\"o}ing-Messing and N.E. Jansen and P. Vos and W.F. Abdo",
note = "{\circledC} 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.",
year = "2018",
doi = "10.1111/ajt.14529",
language = "English",
volume = "18",
pages = "890--896",
journal = "American Journal of Transplantation",
issn = "1600-6143",
publisher = "Wiley-Blackwell Publishing Ltd",
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}

External validation of prediction models for time to death in potential donors after circulatory death. / Kotsopoulos, A.M.M.; Böing-Messing, F.; Jansen, N.E.; Vos, P.; Abdo, W.F.

In: American Journal of Transplantation, Vol. 18, No. 4, 2018, p. 890-896.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - External validation of prediction models for time to death in potential donors after circulatory death

AU - Kotsopoulos, A.M.M.

AU - Böing-Messing, F.

AU - Jansen, N.E.

AU - Vos, P.

AU - Abdo, W.F.

N1 - © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

PY - 2018

Y1 - 2018

N2 - Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot etal (AUC 0.86; 95% CI 0.77-0.95), Wind etal (AUC 0.62; 95% CI 0.49-0.76), Davila etal (AUC 0.80; 95% CI 0.708-0.901) and the Cox regression model by Suntharalingam etal (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.This study externally validates previous predictive models for time to death in controlled donation after circulatory death donors and identifies that absence of brainstem reflexes, persistent ventilatory failure, and aspects of withdrawal of life-support treatment are predictors for death within 60 minutes.

AB - Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot etal (AUC 0.86; 95% CI 0.77-0.95), Wind etal (AUC 0.62; 95% CI 0.49-0.76), Davila etal (AUC 0.80; 95% CI 0.708-0.901) and the Cox regression model by Suntharalingam etal (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.This study externally validates previous predictive models for time to death in controlled donation after circulatory death donors and identifies that absence of brainstem reflexes, persistent ventilatory failure, and aspects of withdrawal of life-support treatment are predictors for death within 60 minutes.

KW - CARDIAC DEATH

KW - DONATION

KW - END

KW - GUIDELINES

KW - HEART-TRANSPLANTATION

KW - INTENSIVE-CARE UNITS

KW - LIFE-SUSTAINING TREATMENT

KW - NETHERLANDS

KW - ORGAN DONORS

KW - WITHDRAWAL

KW - clinical research

KW - donors and donation

KW - donors and donation: donation after circulatory death (DCD)

KW - donors and donation: donor evaluation

KW - organ transplantation in general

KW - practice

U2 - 10.1111/ajt.14529

DO - 10.1111/ajt.14529

M3 - Article

VL - 18

SP - 890

EP - 896

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6143

IS - 4

ER -