Romaniello Caterina, Bertoletti Erik, Matera Nunzio, Farinelli Marina, Pedone Vincenzo
Santa Viola Hospital, Bologna, Italy.
Santa Viola Hospital, Bologna, Italy.
Am J Med Sci. 2016 Jun;351(6):563-9. doi: 10.1016/j.amjms.2016.01.024. Epub 2016 Mar 31.
The life expectancy of patients with disorders of consciousness (DOCs) is ever-increasing, but little is known about their clinical course over late stages. Several issues (premorbid conditions, complications and pressure sores) are to be considered for their effect on clinical outcome, risk of death and recovery of functional performance. Unfortunately, in late stages of long-term rehabilitation, these aspects are still more neglected than in acute and postacute stages. The aim of this study was to investigate the clinical course and the complications of patients in the late stages of DOCs and to explore the relationship between mortality and specific biomarkers.
A total of 112 patients, admitted over 10 years in a dedicated ward, were retrospectively studied. Sociodemographic data, preadmission and inpatient clinical features were collected. Disability Rating Scale scores, complications including pressure sores and blood markers were assessed monthly. Data were analyzed through descriptive statistics and correlations using SPSS.
Most patients were men older than 50 years with a nontraumatic etiology and a history of hypertension (42.86%). The most common complication was pneumonia (76.79%). No association was found between sex and mortality or between etiology and mortality (P > 0.05). Mortality correlated significantly with sepsis (ρ = 0.253), albumin (ρ = -0.558), hemoglobin (ρ = -0.354) and white blood cells (ρ = 0.243). Only 42% of patients remained unchanged at Disability Rating Scale evaluation.
These data confirmed that DOCs are not static conditions and they require ongoing monitoring and assessment of clinical status, level of consciousness and laboratory biomarkers.
意识障碍（DOCs）患者的预期寿命不断增加，但对其晚期临床病程了解甚少。需要考虑几个问题（病前状况、并发症和压疮）对临床结局、死亡风险和功能恢复的影响。不幸的是，在长期康复的晚期，这些方面仍然比急性和亚急性期更被忽视。本研究的目的是调查DOCs晚期患者的临床病程和并发症，并探讨死亡率与特定生物标志物之间的关系。
回顾性研究了在一个专门病房住院超过10年的112例患者。收集了社会人口统计学数据、入院前和住院期间的临床特征。每月评估残疾评定量表评分、包括压疮在内的并发症和血液标志物。使用SPSS通过描述性统计和相关性分析数据。
大多数患者为50岁以上男性，病因非创伤性，有高血压病史（42.86%）。最常见的并发症是肺炎（76.79%）。未发现性别与死亡率之间或病因与死亡率之间存在关联（P>0.05）。死亡率与败血症（ρ=0.253）、白蛋白（ρ=-0.558）、血红蛋白（ρ=-0.354）和白细胞（ρ=0.243）显著相关。在残疾评定量表评估中，只有42%的患者保持不变。
这些数据证实，DOCs不是静态疾病，需要对临床状态、意识水平和实验室生物标志物进行持续监测和评估。
