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. 2023 Jan 23;13(2):194.
doi: 10.3390/brainsci13020194.

Long-Term Outcomes among Patients with Prolonged Disorders of Consciousness

Yan Liu  1 , Xiao-Gang Kang  1 , Qiong Gao  1 , Yu Liu  1 , Chang-Geng Song  1 , Xiao-Jing Shi  1 , Jia-Ning Wu  1 , Wen Jiang  1
Affiliations

Long-Term Outcomes among Patients with Prolonged Disorders of Consciousness

Yan Liu et al. Brain Sci. .

Abstract

Purpose: To evaluate the long-term survival and functional outcomes of patients with prolonged disorders of consciousness (pDoC) 1-8 years after brain injuries.

Methods: Retrospective study to assess the long-term survival and functional outcomes of patients with pDoC was conducted. We performed Cox regression and multivariate logistic regression to calculate hazard ratios (HRs) for the outcome of survival and to identify risk factors of the functional outcome.

Results: We recruited 154 patients with pDoC. The duration of follow-up from disease onset was 1-8 years. The median age was 46 years (IQR, 32-59), and 65.6% (n = 101) of them were men. During the follow-up period, one hundred and ten patients (71.4%) survived; among them, 52 patients had a good outcome. From the overall survival curve, the 1-, 3-, and 8-year survival rates of patients were about 80.5%, 72.0%, and 69.7%, respectively. Cox regression analysis revealed a significant association between the lower APACHE II score (p = 0.005) (cut-off score ≥ 18) and the presence of sleep spindles (p = 0.001) with survival. Logistic regression analysis demonstrated a higher CRS-R score (cut-off score ≥ 7), and presence of sleep spindles were related to a favorable outcome among patients with pDoC.

Conclusions: Sleep spindles are correlated with both long-term survival and long-term functional outcome in pDoC patients.

Keywords: disorders of consciousness; minimal consciousness state; mortality; prognostic; unresponsive wakefulness syndrome.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
Flow diagram showing patient recruitment and outcomes.
Figure 2
Figure 2
Kaplan-Meier plots for the survival rate in patients with prolonged disorders of consciousness. (A) Kaplan-Meier curves are shown for all 154 patients; (B) survival rates are shown depending on diagnosis; (C) survival rates based on different etiologies. MCS: minimally conscious state; UWS: unresponsive wakefulness syndrome.
Figure 3
Figure 3
Functional outcomes according to the Glasgow Outcome Scale-Extended (GOS-E): (A) distribution of GOS-E scores to all patients; (B) distribution of GOS-E scores to different clinical diagnosis; (C) distribution of GOS-E scores to different etiologies; poor outcome: 1. dead, 2. vegetative state, 3. lower severe disability; good outcome: 4. upper severe disability, 5. lower moderate disability, 6. upper moderate disability, 7. lower good recovery, 8. upper good recovery. MCS: minimally conscious state; UWS: unresponsive wakefulness syndrome.
See this image and copyright information in PMC

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