Two-year outcomes of patients with prolonged disorders of consciousness: a prospective cohort study in Russian Federation

Abstract

Background: Epidemiological data on prolonged disorders of consciousness (pDOC) are not available due to lack of research in this field. The objective of this pioneering prospective cohort study in the Russian Federation was to collect the data on the survival and the level of consciousness of patients with pDOC, as well as to search for prognostic markers of survival and improvement of the level of consciousness on long-terms outcomes (up to 24 months).

Methods: All patients (n=184) had pDOC and were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. We assessed the neurological status and acquired follow-up diagnosis as well. Out of total patients: anoxic brain injury (ABI) (n=52), vascular lesions (VL) (n=50), traumatic brain injury (TBI) (n=74), and other causes (n=8). Changes in patients' vital and conscious status were recorded in four-time slices: 3, 6, 12, and 24 months after the event that led to pDOC.

Results: The survival rate is less than 30%, and the rate of recovery in terms of consiousness is 21%, which are both low, though do not differ significantly from existing data for this category of patients. Unprofessional home care may have a role to play in the declined long-term survival rate. We still do not have reliable prognostic markers among demographical and clinical indices; however, younger age can be considered the only significant predictor of survival and positive dynamics in the level of consciousness.

Conclusions: We expect that our research will help to personalize and help the patient and families with the appropriate clinical as well as social measures.

Keywords: Rehabilitation; medical care; minimally conscious state (MCS); prolonged disorders of consciousness (pDOC); vegetative state (VS).