Article (Scientific journals)
Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: An international multicentre study.
Estraneo, Anna; Magliacano, Alfonso; Fiorenza, Salvatore et al.
2021In European Journal of Neurology
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Keywords :
disorders of consciousness; minimally conscious state; mortality; prognosis; vegetative state
Abstract :
[en] 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.
Disciplines :
Neurology
Author, co-author :
Estraneo, Anna
Magliacano, Alfonso
Fiorenza, Salvatore
Formisano, Rita
Grippo, Antonello
Angelakis, Efthymios
Cassol, Helena ;  Université de Liège - ULiège > Département d'aérospatiale et mécanique > Ingénierie des véhicules terrestres
Thibaut, Aurore ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Gosseries, Olivia  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Lamberti, Gianfranco
Noé, Enrique
Bagnato, Sergio
Edlow, Brian L.
Chatelle, Camille
Lejeune, Nicolas  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Veeramuthu, Vigneswaran
Bartolo, Michelangelo
Mattia, Donatella
Toppi, Jlenia
Zasler, Nathan
Schnakers, Caroline
Trojano, Luigi
More authors (12 more) Less
Language :
English
Title :
Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: An international multicentre study.
Publication date :
2021
Journal title :
European Journal of Neurology
ISSN :
1351-5101
eISSN :
1468-1331
Publisher :
Blackwell, Oxford, United Kingdom
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
© 2021 European Academy of Neurology.
Available on ORBi :
since 03 February 2022

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