Risk factors for 2‐year mortality in patients with prolonged disorders of consciousness: An international multicentre study. (25th October 2021)

• Record Type: Journal Article
• Authors: Estraneo, Anna; Magliacano, Alfonso; Fiorenza, Salvatore; Formisano, Rita; Grippo, Antonello; Angelakis, Efthymios; Cassol, Helena; Thibaut, Aurore; Gosseries, Olivia; Lamberti, Gianfranco; Noé, Enrique; Bagnato, Sergio; Edlow, Brian L.; Chatelle, Camille; Lejeune, Nicolas; Veeramuthu, Vigneswaran; Bartolo, Michelangelo; Mattia, Donatella; Toppi, Jlenia; Zasler, Nathan; Schnakers, Caroline; Trojano, Luigi
• Is Part Of: European journal of neurology. Volume 29:Number 2(2022)
• Page Start: 390
• Page End: 399
• Publication Date: 2021-10-25
• Subjects: disorders of consciousness -- minimally conscious state -- mortality -- prognosis -- vegetative state; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.15143
• Languages: English
• ISSNs: 1351-5101

Abstract

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. Abstract : Data from an international multicentre prospective cohort study were analysed to evaluate 2‐year mortality rate and bedside predictors of mortality in prolonged disorders of consciousness. Of 143 patients enrolled (vegetative state/unresponsive wakefulness syndrome [VS/UWS], n = 68; minimally conscious state [MCS], n = 75), 41 (28.7%) died within 24 months postinjury. Significant predictors of mortality in VS/UWS were older age and lower Coma Recovery Scale–Revised total score, whereas in MCS female sex and absence of alpha rhythm on electroencephalogram at study entry were significant predictors.