Pistoia Francesca, Sacco Simona, Franceschini Marco, Sarà Marco, Pistarini Caterina, Cazzulani Benedetta, Simonelli Ilaria, Pasqualetti Patrizio, Carolei Antonio
1 Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy .
J Neurotrauma. 2015 May 15;32(10):682-8. doi: 10.1089/neu.2014.3659. Epub 2015 Feb 19.
The aim of this study was to identify the impact of comorbidities on outcomes of patients with vegetative state (VS) or minimally conscious state (MCS). All patients in VS or MCS consecutively admitted to two postacute care units within a 1-year period were evaluated at baseline and at 6 months through the Coma Recovery Scale-Revised Version and the Disability Rating Scale (DRS). Comorbidities were also recorded for each patient along the same period. Six-month outcomes included death, full recovery of consciousness, and functional improvement. One hundred and thirty-nine patients (88 male and 51 female; median age, 59 years) were included. Ninety-seven patients were in VS (70%) and 42 in MCS (30%). At 6 months, 33 patients were dead (24%), 39 had a full recovery of consciousness (28%), and 67 remained in VS or MCS (48%). According to DRS scores, 40% of patients (n=55) showed a functional improvement in the level of disability. One hundred and thirty patients (94%) showed at least one comorbidity. Severity of comorbidities (hazard ratio [HR]=2.8; 95% confidence interval [CI], 1.71-4.68; p<0.001) and the presence of ischemic or organic heart diseases (HR=2.6; 95% CI, 1.21-5.43; p=0.014) were the strongest predictors of death, together with increasing age (HR=1.0; 95% CI, 1.0-1.06; p=0.033). Respiratory diseases and arrhythmias without organic heart diseases were negative predictors of full recovery of consciousness (odds ratio [OR]=0.3; 95% CI, 0.12-0.7; p=0.006; OR=0.2; 95% CI, 0.07-0.43; p<0.001) and functional improvement (OR=0.4; 95% CI, 0.15-0.85, p=0.020; OR=0.2; 95% CI, 0.08-0.45; p<0.001). Our data show that comorbidities are common in these patients and some of them influence recovery of consciousness and outcomes.
本研究的目的是确定合并症对植物状态（VS）或微意识状态（MCS）患者预后的影响。在1年期间连续入住两个急性后期护理单元的所有VS或MCS患者在基线时以及6个月时通过修订版昏迷恢复量表和残疾评定量表（DRS）进行评估。在同一时期还记录了每位患者的合并症。6个月时的预后包括死亡、意识完全恢复和功能改善。共纳入139例患者（88例男性和51例女性；中位年龄59岁）。97例患者处于VS状态（70%），42例处于MCS状态（30%）。6个月时，33例患者死亡（24%），39例意识完全恢复（28%），67例仍处于VS或MCS状态（48%）。根据DRS评分，40%的患者（n = 55）在残疾水平上有功能改善。130例患者（94%）至少有一种合并症。合并症的严重程度（风险比[HR]=2.8；95%置信区间[CI]，1.71 - 4.68；p<0.001）以及缺血性或器质性心脏病的存在（HR = 2.6；95% CI，1.21 - 5.43；p = 0.014）是死亡的最强预测因素，年龄增加也是如此（HR = 1.0；95% CI，1.0 - 1.06；p = 0.033）。呼吸系统疾病和无器质性心脏病的心律失常是意识完全恢复（优势比[OR]=0.3；95% CI，0.12 - 0.7；p = 0.006；OR = 0.2；95% CI，0.07 - 0.43；p<0.001）和功能改善（OR = 0.4；95% CI，0.15 - 0.85，p = 0.020；OR = 0.2；95% CI，0.08 - 0.45；p<0.001）的负性预测因素。我们的数据表明，合并症在这些患者中很常见，其中一些会影响意识恢复和预后。
