Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy.
Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy.
Eur J Neurol. 2022 Feb;29(2):390-399. doi: 10.1111/ene.15143. Epub 2021 Oct 25.
Patients with prolonged disorders of consciousness (pDoC) have a high mortality rate due to medical complications. Because an accurate prognosis is essential for decision-making on patients' management, we analysed data from an international multicentre prospective cohort study to evaluate 2-year mortality rate and bedside predictors of mortality.
We enrolled adult patients in prolonged vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) after traumatic and nontraumatic brain injury within 3 months postinjury. At enrolment, we collected demographic (age, sex), anamnestic (aetiology, time postinjury), clinical (Coma Recovery Scale-Revised [CRS-R], Disability Rating Scale, Nociception Coma Scale-Revised), and neurophysiologic (electroencephalogram [EEG], somatosensory evoked and event-related potentials) data. Patients were followed up to gather data on mortality up to 24 months postinjury.
Among 143 traumatic (n = 55) and nontraumatic (n = 88) patients (VS/UWS, n = 68, 19 females; MCS, n = 75, 22 females), 41 (28.7%) died within 24 months postinjury. Mortality rate was higher in VS/UWS (42.6%) than in MCS (16%; p < 0.001). Multivariate regression in VS/UWS showed that significant predictors of mortality were older age and lower CRS-R total score, whereas in MCS female sex and absence of alpha rhythm on EEG at study entry were significant predictors.
This study demonstrated that a feasible multimodal assessment in the postacute phase can help clinicians to identify patients with pDoC at higher risk of mortality within 24 months after brain injury. This evidence can help clinicians and patients' families to navigate the complex clinical decision-making process and promote an international standardization of prognostic procedures for patients with pDoC.
由于医疗并发症，持续性意识障碍（pDoC）患者的死亡率很高。由于准确的预后对于患者管理决策至关重要，因此我们分析了一项国际多中心前瞻性队列研究的数据，以评估 2 年死亡率和床边死亡率预测因素。
我们纳入了创伤性和非创伤性脑损伤后 3 个月内处于延长植物状态/无反应觉醒综合征（VS/UWS）或最小意识状态（MCS）的成年患者。在入组时，我们收集了人口统计学（年龄、性别）、病史（病因、受伤后时间）、临床（昏迷恢复量表修订版 [CRS-R]、残疾评定量表、修订后的伤害性昏迷量表）和神经生理学（脑电图 [EEG]、体感诱发电位和事件相关电位）数据。对患者进行随访，以收集受伤后 24 个月内的死亡率数据。
在 143 例创伤性（n=55）和非创伤性（n=88）患者（VS/UWS，n=68，19 名女性；MCS，n=75，22 名女性）中，有 41 例（28.7%）在 24 个月内死亡。VS/UWS 组的死亡率（42.6%）高于 MCS 组（16%）（p<0.001）。在 VS/UWS 中，多变量回归显示死亡率的显著预测因素是年龄较大和 CRS-R 总分较低，而在 MCS 中，女性性别和研究开始时 EEG 上无α节律是显著预测因素。
本研究表明，在急性期后进行可行的多模态评估可以帮助临床医生识别出在脑损伤后 24 个月内死亡风险较高的 pDoC 患者。这一证据可以帮助临床医生和患者家属进行复杂的临床决策，并促进 pDoC 患者预后程序的国际化标准化。
