Noé E, Olaya J, Colomer C, Moliner B, Ugart P, Rodriguez C, Llorens R, Ferri J
Servicio de Neurorrehabilitación y Daño Cerebral, Hospitales Vithas-NISA, Fundación Hospitales Vithas-NISA, Valencia, España.
Servicio de Neurorrehabilitación y Daño Cerebral, Hospitales Vithas-NISA, Fundación Hospitales Vithas-NISA, Valencia, España.
Neurologia (Engl Ed). 2019 Nov-Dec;34(9):589-595. doi: 10.1016/j.nrl.2017.04.004. Epub 2017 Jul 14.
Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established.
Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS.
In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P<.01), chronicity (P=.01), and CRS-R scores at admission (P<.001) correctly predicted emergence from MCS in 77.5% of the cases.
UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated.
意识改变状态传统上一直与预后不良相关。目前，这些状态之间的临床差异正开始得到明确。
我们的研究纳入了37例根据修订的昏迷恢复量表（CRS-R）诊断为植物状态/无反应觉醒综合征（UWS）的患者和43例处于最小意识状态（MCS）的患者。所有患者每月使用CRS-R进行至少6个月的随访。我们根据多学会特别工作组确定的临界点记录植物状态从“持续性”进展到“永久性”的时间点：创伤性损伤患者为12个月，非创伤性损伤患者为3个月。使用逻辑回归模型来确定可能预测哪些患者将从MCS中苏醒的因素。
在UWS组中，23例患者从UWS中苏醒，但只有9例从MCS中苏醒。在MCS组的43例患者中，26例患者在随访期间从该状态中苏醒。从UWS中苏醒的23例患者中有8例（34.7%）以及从MCS中苏醒的35例患者中有17例（48.6%）在多学会特别工作组提出的时间点之后恢复。根据多变量回归分析，病因（P<0.01）、病程（P=0.01）和入院时的CRS-R评分（P<0.001）在77.5%的病例中正确预测了从MCS中苏醒的情况。
UWS和MCS在诊断和预后方面是不同的临床状态。一些传统上与预后不良相关的因素，如受伤时间和恢复可能性，应该重新评估。
