TY - JOUR
TI - Risk factors for 2-year mortality in patients with prolonged disorders
of consciousness: An international multicentre study
AU - Estraneo, Anna
AU - Magliacano, Alfonso
AU - Fiorenza, Salvatore and
AU - Formisano, Rita
AU - Grippo, Antonello
AU - Angelakis, Efthymios and
AU - Cassol, Helena
AU - Thibaut, Aurore
AU - Gosseries, Olivia
AU - Lamberti,
AU - Gianfranco
AU - Noe, Enrique
AU - Bagnato, Sergio
AU - Edlow, Brian L. and
AU - Chatelle, Camille
AU - Lejeune, Nicolas
AU - Veeramuthu, Vigneswaran and
AU - Bartolo, Michelangelo
AU - Mattia, Donatella
AU - Toppi, Jlenia and
AU - Zasler, Nathan
AU - Schnakers, Caroline
AU - Trojano, Luigi
JO - European Journal of Paediatric Neurology
PY - 2022
VL - 29
TODO - 2
SP - 390-399
PB - Wiley
SN - 1090-3798
TODO - 10.1111/ene.15143
TODO - disorders of consciousness; minimally conscious state; mortality;
prognosis; vegetative state
TODO - Background and purpose 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. Methods 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. Results 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. Conclusions 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.
ER -