Yan Dong, Simei Liu, Hongzhao Bai, Hongyan Du, Yuchao Ding
Department of Rehabilitation Medicine, Hospital of Zhejiang People's Armed Police, Hangzhou, China.
Front Public Health. 2024 Jul 24;12:1421779. doi: 10.3389/fpubh.2024.1421779. eCollection 2024.
The findings regarding the prognosis of prolonged disorders of consciousness (PDOC) vary widely among different studies. This study aims to investigate the mortality, consciousness recovery and disabilities of patients with PDOC after brain injury.
A total of 204 patients with PDOC were included in a longitudinal cohort study, including 129 males and 75 females. There were 112 cases of traumatic brain injury (TBI), 62 cases of cerebral hemorrhage (CH), 13 cases of cerebral infarction (CI) and 17 cases of ischemic hypoxic encephalopathy (IHE). The status of consciousness at 1, 2, 3, 6, 12, 18, 24, 36, 48 months of the disease course was assessed or followed up using the Revised Coma Recovery Scale (CRS-R). If the patients were conscious, the disability Rating Scale (DRS) was also performed. The prognosis of different PDOC including coma, vegetative state (VS) and minimal conscious state (MCS) was analyzed. The survival patients were screened for variables and included in multivariate binary Logistic regression to screen the factors affecting the recovery of consciousness.
The mortality rates at 12, 24, 36, and 48 months were 10.7, 23.4, 38.9, and 68.4%, respectively. The median time of death was 18 months (8.75, 29). The probability of MCS regaining consciousness was higher than VS ( < 0.05), with the degree of disability left lower than VS ( < 0.05). There was no significant difference between MCS- and MCS+ groups in terms of the probability of regaining consciousness, the extent of residual disability, and mortality rates ( > 0.05). The mortality rate of coma was higher than that of other PDOC ( < 0.05). The mortality rate of MCS was lower than that of VS, but the difference was not statistically significant ( > 0.05). The probability of consciousness recovery after TBI was the highest and the mortality rate was the lowest. The possibility of consciousness recovery in IHE was the least, and the mortality rate of CI was the highest. The cause of brain injury and initial CRS-R score were the factors affecting the consciousness recovery of patients ( < 0.05).
The prognosis of MCS is more favorable than VS, with comparable outcomes between MCS- and MCS+, while comatose patients was the poorest. TBI has the best prognosis and IHE has the worst prognosis.
关于长期意识障碍（PDOC）预后的研究结果在不同研究中差异很大。本研究旨在调查脑损伤后PDOC患者的死亡率、意识恢复情况和残疾情况。
一项纵向队列研究共纳入204例PDOC患者，其中男性129例，女性75例。创伤性脑损伤（TBI）112例，脑出血（CH）62例，脑梗死（CI）13例，缺血缺氧性脑病（IHE）17例。使用修订的昏迷恢复量表（CRS-R）评估或随访病程1、2、3、6、12、18、24、36、48个月时的意识状态。如果患者有意识，还需进行残疾评定量表（DRS）评估。分析不同PDOC（包括昏迷、植物状态（VS）和最小意识状态（MCS））的预后情况。对存活患者进行变量筛选，并纳入多因素二元Logistic回归分析以筛选影响意识恢复的因素。
12、24、36和48个月时的死亡率分别为10.7%、23.4%、38.9%和68.4%。死亡的中位时间为18个月（8.75，29）。MCS恢复意识的概率高于VS（<0.05），遗留的残疾程度低于VS（<0.05）。MCS-组和MCS+组在意识恢复概率、残余残疾程度和死亡率方面无显著差异（>0.05）。昏迷的死亡率高于其他PDOC（<0.05）。MCS的死亡率低于VS，但差异无统计学意义（>0.05）。TBI后意识恢复的概率最高，死亡率最低。IHE意识恢复的可能性最小，CI的死亡率最高。脑损伤原因和初始CRS-R评分是影响患者意识恢复的因素（<0.05）。
MCS的预后优于VS，MCS-组和MCS+组的结果相当，而昏迷患者的预后最差。TBI的预后最好，IHE的预后最差。
