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
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Bibliography
Kondziella D, Bender A, Diserens K, et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020;27(5):741-756. https://doi.org/10.1111/ene.14151
Laureys S, Celesia GG, Cohadon F, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010;8:2-5. https://doi.org/10.1186/1741-7015-8-68
Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349-353. https://doi.org/10.1212/WNL.58.3.349
Faugeras F, Rohaut B, Valente M, et al. Survival and consciousness recovery are better in the minimally conscious state than in the vegetative state. Brain Inj. 2018;32(1):72-77. https://doi.org/10.1080/02699052.2017.1364421
Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, Trojano L. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. 2010;75(3):239-245.
Estraneo A, Loreto V, Masotta O, Pascarella A, Trojano L. Do medical complications impact long-term outcomes in prolonged disorders of consciousness? Arch Phys Med Rehabil. 2018;99(12):2523-2531.e3. https://doi.org/10.1016/j.apmr.2018.04.024
Estraneo A, De Bellis F, Masotta O, et al. Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state. Brain Inj. 2019;33(13-14):1633-1639. https://doi.org/10.1080/02699052.2019.1658220
Noé E, Ferri J, Olaya J, et al. When, how, and to what extent are individuals with unresponsive wakefulness syndrome able to progress? Neurobehavioral progress. Brain Sci. 2021;11(1):126. https://doi.org/10.3390/brainsci11010126
Lopez-Rolon A, Vogler J, Howell K, et al. Severe disorders of consciousness after acquired brain injury: a single-centre long-term follow-up study. NeuroRehabilitation. 2017;40(4):509-517. https://doi.org/10.3233/NRE-171438
Giacino JT, Kalmar K, Whyte J. The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85(12):2020-2029. https://doi.org/10.1016/j.apmr.2004.02.033
Estraneo A, Moretta P, Loreto V, et al. Predictors of recovery of responsiveness in prolonged anoxic vegetative state. Neurology. 2013;80(5):464-470. https://doi.org/10.1212/WNL.0b013e31827f0f31
Luauté J, Maucort-Boulch D, Tell L, et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology. 2010;75(3):246-252. https://doi.org/10.1212/WNL.0b013e3181e8e8df
Bagnato S, Boccagni C, Prestandrea C, Sant'Angelo A, Castiglione A, Galardi G. Prognostic value of standard EEG in traumatic and non-traumatic disorders of consciousness following coma. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2010;121(3):274-280. https://doi.org/10.1016/j.clinph.2009.11.008
Bagnato S, Boccagni C, Sant'Angelo A, Prestandrea C, Mazzilli R, Galardi G. EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2015;126(5):959-966. https://doi.org/10.1016/j.clinph.2014.08.005
Kotchoubey B, Pavlov YG. A systematic review and meta-analysis of the relationship between brain data and the outcome in disorders of consciousness. Front Neurol. 2018;9:315. https://doi.org/10.3389/fneur.2018.00315
Estraneo A, Trojano L. Prognosis in disorders of consciousness. In: Schnakers C, Laureys S, eds. Coma and Disorders of Consciousness. Berlin: Springer International Publishing, 2018: 17-36. https://doi.org/10.1007/978-3-319-55964-3
Estraneo A, Fiorenza S, Magliacano A, et al. Multicenter prospective study on predictors of short-term outcome in disorders of consciousness. Neurology. 2020;95(11):e1488-e1499. https://doi.org/10.1212/WNL.0000000000010254
Wannez S, Heine L, Thonnard M, Gosseries O, Laureys S. The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol. 2017;81:883-889. https://doi.org/10.1002/ana.24962
Chatelle C, Majerus S, Whyte J, Laureys S, Schnakers C. A sensitive scale to assess nociceptive pain in patients with disorders of consciousness. J Neurol Neurosurg Psychiatry. 2012;83(12):1233-1237. https://doi.org/10.1136/jnnp-2012-302987
Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil. 1982;63(3):118-123.
Estraneo A, Loreto V, Guarino I, et al. Standard EEG in diagnostic process of prolonged disorders of consciousness. Clin Neurophysiol. 2016;127(6):2379-2385. https://doi.org/10.1016/j.clinph.2016.03.021
Cruccu G, Aminoff MJ, Curio G, et al. Recommendations for the clinical use of somatosensory-evoked potentials. Clin Neurophysiol off J Int Fed Clin Neurophysiol. 2008;119(8):1705-1719. https://doi.org/10.1016/j.clinph.2008.03.016
Duncan CC, Barry RJ, Connolly JF, et al. Event-related potentials in clinical research: guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400. Clin Neurophysiol. 2009;120(11):1883-1908. https://doi.org/10.1016/j.clinph.2009.07.045
Steppacher I, Kaps M, Kissler J. Will time heal? A long-term follow-up of severe disorders of consciousness. Ann Clin Transl Neurol. 2014;1(6):401-408. https://doi.org/10.1002/acn3.63
Estraneo A, Masotta O, Bartolo M, et al. Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies. Brain Inj. 2020;35(1):1-7. https://doi.org/10.1080/02699052.2020.1861652
Formisano R, Contrada M, Aloisi M, et al. Improvement rate of patients with severe brain injury during post-acute intensive rehabilitation. Neurol Sci off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2018;39(4):753-755. https://doi.org/10.1007/s10072-017-3203-3
Mosenthal AC, Lavery RF, Addis M, et al. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52(5):907-911. https://doi.org/10.1097/00005373-200205000-00015
Portaccio E, Morrocchesi A, Romoli AM, et al. Score on coma recovery scale-revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury. Brain Inj. 2018;32(6):730-734. https://doi.org/10.1080/02699052.2018.1440420
Gerrard P, Zafonte R, Giacino JT. Coma recovery scalee-revised: evidentiary support for hierarchical grading of level of consciousness. Arch Phys Med Rehabil. 2014;95(12):2335-2341. https://doi.org/10.1016/j.apmr.2014.06.018
Harrison-Felix CL, Whiteneck GG, Jha A, DeVivo MJ, Hammond FM, Hart DM. Mortality over four decades after traumatic brain injury rehabilitation: a retrospective cohort study. Arch Phys Med Rehabil. 2009;90(9):1506-1513. https://doi.org/10.1016/j.apmr.2009.03.015
Farace E, Alves WM. Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury. Neurosurg Focus. 2000;8(1):e6. https://doi.org/10.3171/foc.2000.8.1.152
Mikolić A, van Klaveren D, Groeniger JO, et al. Differences between men and women in treatment and outcome after traumatic brain injury. J Neurotrauma. 2021;38(2):235-251. https://doi.org/10.1089/neu.2020.7228
Brown SB, Colantonio A, Kim H. Gender differences in discharge destination among older adults following traumatic brain injury. Health Care Women Int. 2012;33(10):896-904. https://doi.org/10.1080/07399332.2012.673654
Moretta P, Estraneo A, De Lucia L, Cardinale V, Loreto V, Trojano L. A study of the psychological distress in family caregivers of patients with prolonged disorders of consciousness during in-hospital rehabilitation. Clin Rehabil. 2014;28(7):717-725. https://doi.org/10.1177/0269215514521826
D'Ippolito M, Aloisi M, Azicnuda E, et al. Changes in caregivers lifestyle after severe acquired brain injury: a preliminary investigation. Biomed Res Int. 2018;2018:2824081. https://doi.org/10.1155/2018/2824081
Scarpino M, Lolli F, Hakiki B, et al. Prognostic value of post-acute EEG in severe disorders of consciousness, using American Clinical Neurophysiology Society terminology. Neurophysiol Clin. 2019;49(4):317-327. https://doi.org/10.1016/j.neucli.2019.07.001
Scarpino M, Lolli F, Hakiki B, et al. EEG and coma recovery scale-revised prediction of neurological outcome in disorder of consciousness patients. Acta Neurol Scand. 2020;142(3):221-228. https://doi.org/10.1111/ane.13247
Fingelkurts AA, Fingelkurts AA, Bagnato S, Boccagni C, Galardi G. Life or death: prognostic value of a resting EEG with regards to survival in patients in vegetative and minimally conscious States. PLoS One. 2011;6(10):e25967. https://doi.org/10.1371/journal.pone.0025967
Beridze M, Khaburzania M, Shakarishvili R, Kazaishvili D. Dominated EEG patterns and their prognostic value in coma caused by traumatic brain injury. Georgian Med News. 2010;186:28-33.
Klimesch W. EEG alpha and theta oscillations reflect cognitive and memory performance: a review and analysis. Brain Res Brain Res Rev. 1999;29(2-3):169-195. https://doi.org/10.1016/s0165-0173(98)00056-3
Schiff ND. Recovery of consciousness after brain injury: a mesocircuit hypothesis. Trends Neurosci. 2010;33(1):1-9. https://doi.org/10.1016/j.tins.2009.11.002
Chennu S, Annen J, Wannez S, et al. Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness. Brain. 2017;140(8):2120-2132. https://doi.org/10.1093/brain/awx163
Bruno M-A, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol. 2011;258(7):1373-1384. https://doi.org/10.1007/s00415-011-6114-x
Bagnato S, Boccagni C, Prestandrea C, Fingelkurts AA, Fingelkurts AA, Galardi G. Changes in standard electroencephalograms parallel consciousness improvements in patients with unresponsive wakefulness syndrome. Arch Phys Med Rehabil. 2017;98(4):665-672. https://doi.org/10.1016/j.apmr.2016.09.132
Azabou E, Fischer C, Mauguiere F, et al. Prospective cohort study evaluating the prognostic value of simple EEG parameters in postanoxic coma. Clin EEG Neurosci. 2016;47(1):75-82. https://doi.org/10.1177/1550059415612375
Steppacher I, Fuchs P, Kaps M, Nussbeck FW, Kissler J. A tree of life? Multivariate logistic outcome-prediction in disorders of consciousness. Brain Inj. 2020;34(3):399-406. https://doi.org/10.1080/02699052.2019.1695289
Tsetsou S, Novy J, Oddo M, Rossetti AO. EEG reactivity to pain in comatose patients: importance of the stimulus type. Resuscitation. 2015;97:34-37. https://doi.org/10.1016/j.resuscitation.2015.09.380
Formisano R, Contrada M, Aloisi M, et al. Nociception Coma Scale with personalized painful stimulation versus standard stimulus in non-communicative patients with disorders of consciousness. Neuropsychol Rehabil. 2020;30(10):1893-1904. https://doi.org/10.1080/09602011.2019.1614464
Schnakers C, Hirsch M, Noé E, et al. Covert cognition in disorders of consciousness: a meta-analysis. Brain Sci. 2020;10(12):930. https://doi.org/10.3390/brainsci10120930
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