Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China.
Neurocrit Care. 2022 Jun;36(3):727-737. doi: 10.1007/s12028-021-01308-y. Epub 2021 Jul 21.
Our objective was to evaluate the use of event-related potentials and the middle-latency somatosensory evoked potential (MLSEP) for the prediction of awakening in coma, determine the evaluation day that evoked potentials (EPs) best predict an awakening outcome, and determine whether the mismatch negativity (MMN) combined with the MLSEP, when recorded at 7 days after coma, improved the prediction of awakening from coma.
Design prospective blinded cohort study. Setting neurointensive care unit of a university hospital. Patients 113 consecutive patients who were severely comatose, whose etiologies of coma included stroke (65 patients), hypoxic-ischemic encephalopathy (28 patients), intracranial infection (6 patients), and other (14 patients). Interventions none. Measurements we gathered Glasgow Coma Scale scores and recorded EPs for all patients who were comatose at 7, 14, and 30 days after coma onset, unless the patients returned to consciousness. The EPs examined included the MLSEP, the middle-latency auditory evoked potential, the N100, and the MMN. With telephone follow-up after 3 months, the patients were classified as awakening or nonawakening according to Glasgow Outcome Scale.
When predicting an awakening outcome, at least the unilateral presence of the N60 had the highest sensitivity (82.7%), whereas the presence of the MMN showed the highest specificity (82.0%). The area under the receiver operating characteristic curve for the EPs were high at 7 days after coma onset. At 7 days after coma onset, the combination of the N60 and MMN offered good predictive performance for awakening (area under the receiver operating characteristic curve = 0.852, 95% confidence interval 0.765-0.940), with increased sensitivity (70.0%) and improved specificity (91.7%).
The N60 and MMN were the strongest prognostic factors for an awakening outcome. Furthermore, at 7 days after coma onset, the combination of the N60 and MMN improved the prediction of an awakening outcome in patients who were comatose.
我们的目的是评估事件相关电位和中潜伏期体感诱发电位（MLSEP）在昏迷患者觉醒预测中的作用，确定诱发电位（EP）最佳预测觉醒结局的评估日，并确定昏迷后 7 天记录的失匹配负波（MMN）与 MLSEP 相结合是否能提高昏迷患者觉醒的预测能力。
前瞻性盲队列研究设计。研究场所为一所大学医院的神经重症监护病房。研究对象为 113 例连续昏迷患者，其昏迷病因包括卒中（65 例）、缺氧缺血性脑病（28 例）、颅内感染（6 例）和其他（14 例）。干预措施无。所有昏迷患者在昏迷后 7、14 和 30 天测量格拉斯哥昏迷量表评分并记录 EP，除非患者恢复意识。检查的 EP 包括 MLSEP、中潜伏期听觉诱发电位、N100 和 MMN。通过 3 个月后的电话随访，根据格拉斯哥结局量表将患者分为觉醒或未觉醒。
在预测觉醒结局时，至少单侧 N60 的敏感性最高（82.7%），而 MMN 的特异性最高（82.0%）。昏迷后 7 天 EP 的受试者工作特征曲线下面积较高。昏迷后 7 天，N60 和 MMN 的组合对觉醒有较好的预测性能（受试者工作特征曲线下面积=0.852，95%置信区间 0.765-0.940），敏感性提高（70.0%），特异性改善（91.7%）。
N60 和 MMN 是预测觉醒结局的最强预后因素。此外，昏迷后 7 天，N60 和 MMN 的组合改善了昏迷患者觉醒结局的预测。
