Anna Estraneo1,2, Alfonso Magliacano1,3, Salvatore Fiorenza4, Rita Formisano5, Antonello Grippo1, Efthymios Angelakis6, Helena Cassol7, Aurore Thibaut7, Olivia Gosseries7, Gianfranco Lamberti8, Enrique Noé9, Sergio Bagnato10, Brian L Edlow11, Camille Chatelle11, Nicolas Lejeune12, Vigneswaran Veeramuthu13, Michelangelo Bartolo14, Donatella Mattia5, Jlenia Toppi15, Nathan Zasler16, Caroline Schnakers17, Luigi Trojano3. 1. Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy. 2. Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy. 3. Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy. 4. Maugeri Clinical Scientific Institutes, Scientific Institute for Research and Health Care, Laboratory for the Multimodal Evaluation of Disorders of Consciousness, Telese Terme, Italy. 5. Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy. 6. Neurosurgery Department, University of Athens Medical School, Athens, Greece. 7. Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium. 8. Neurorehabilitation and Vegetative State Unit E. Viglietta, Cuneo, Italy. 9. NEURORHB-Neurorehabilitation Service of Vithas Hospitals, Valencia, Spain. 10. Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy. 11. Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA. 12. Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium. 13. Department of Psychology, University of Reading Malaysia, Iskandar Puteri, Malaysia. 14. Neurorehabilitation Unit, HABILITA Zingonia/Ciserano, Bergamo, Italy. 15. Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy. 16. Concussion Care Centre of Virginia, Richmond, Virginia, USA. 17. Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA.
Abstract
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.
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.
Authors: Piergiuseppe Liuzzi; Alfonso Magliacano; Francesco De Bellis; Andrea Mannini; Anna Estraneo Journal: Sci Rep Date: 2022-08-05 Impact factor: 4.996