One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness.

Julia Nekrasova,Elena Luginina,Marina V Petrova,Pranil Pradhan,Mikhail Kanarskii,Igor Pryanikov,Maria Smirnova,Vera Pasko,Ilya Borisov,Denis Shunenkov,Alexey Vorobiev

doi:10.3390/brainsci11050651

Abstract

This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.

Highlights

Severe traumatic brain injuries (TBI), vascular lesions (VL), respiratory or cardiac arrest, and gross metabolic impairments often lead, in the outcome of a coma, to the formation of disorders of consciousness (DOC) such as vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) [1,2]
Epidemiological data obtained as a result of this study indicate the prevalence of TBI among all etiologies leading to DOC, which is consistent with the data of other large studies [15]
We can conclude that higher Coma Recovery ScaleRevised (CRS-R) score and the level of consciousness between patients in VS/UWS and MCS− do not predict a considerably better outcome, and we cannot say that patients in MCS− are more likely to regain consciousness than patients in VS

Summary

Introduction

Severe traumatic brain injuries (TBI), vascular lesions (VL), respiratory or cardiac arrest, and gross metabolic impairments often lead, in the outcome of a coma, to the formation of disorders of consciousness (DOC) such as vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) [1,2]. Persistent DOC develops in 1–14% of TBI patients, and around 12% in non-traumatic injuries [7]. The search for such methods is carried out in the field of instrumental diagnostics and electrophysiology; a comparison of demographic, clinical, and follow-up data can help identify prognostic markers of survival and outcome of the disease, determine an adequate vector of the rehabilitation route, personify cognitive rehabilitation, and correctly inform the patient’s relatives and social services

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