Τίτλος:
Risk factors for 2-year mortality in patients with prolonged disorders
of consciousness: An international multicentre study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Estraneo, Anna
Magliacano, Alfonso
Fiorenza, Salvatore and
Formisano, Rita
Grippo, Antonello
Angelakis, Efthymios and
Cassol, Helena
Thibaut, Aurore
Gosseries, Olivia
Lamberti,
Gianfranco
Noe, Enrique
Bagnato, Sergio
Edlow, Brian L. and
Chatelle, Camille
Lejeune, Nicolas
Veeramuthu, Vigneswaran and
Bartolo, Michelangelo
Mattia, Donatella
Toppi, Jlenia and
Zasler, Nathan
Schnakers, Caroline
Trojano, Luigi
Περιοδικό:
European Journal of Paediatric Neurology
Λέξεις-κλειδιά:
disorders of consciousness; minimally conscious state; mortality;
prognosis; vegetative state
