One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Assessment of the Level of Consciousness and Diagnostic Procedure
2.3. Follow-Up Data Collection
2.4. Statistical Data Analysis
2.5. Legal Issues
3. Results
3.1. Demographical and Clinical Data
3.2. Mortality within First Year after Brain Injury
3.3. Changes in the Level of Consciousness during the First Year after the Brain Injury
3.4. Predictors of Survival and Recovery of Consciousness in Patients with Chronic DOC
- The initial CRS-R score;
- Etiology;
- Gender and age of patients.
3.4.1. The Initial CRS-R Score
3.4.2. Etiology: Mortality and Changes in Consciousness Level
3.4.3. Gender and Age
3.4.4. Logistic Regression Analysis
4. Discussion
- The remote method for determining the level of consciousness at the post-hospital stage, which does not exclude errors in the differential diagnosis of DOC. To minimize erroneous results, we abandoned the scale assessment, which can only be carried out with direct contact with the patient.
- The relatively short duration of the study. In the context of the tendencies towards the abolition of the term “permanent” in relation to DOC, it is more rational to assess the above indicators at a longer stage.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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No. | Study | Number of Patients According to the Level of Consciousness | Number of Patients according to the Etiology | Survival Rate, Level of Consciousness/Number of Patients/Years of Follow-Up | Improvement of Consciousness, Level of Consciousness/Number of Patients/Years of Follow-Up |
---|---|---|---|---|---|
1 | Nakase-Richardson et al., 1977 [8] | VS/UWS + MCS—396 | TBI—396 | VS/UWS + MCS/368/2 | VS/UWS + MCS/28/3 |
2 | Higashi et al., 1977 [9] | VS/UWS—10, MCS—0 | TBI—about 1/3, VL—about 1/5 | VS/UWS/65/1 VS/UWS/39/3 | VS/UWS/9/1 |
3 | Luaute et al., 2010 [10] | VS/UWS—12, MCS—39 | TBI—18, ABI—16, Other—17 | VS/UWS/3/5 MCS/25/5 | VS/UWS/0/5 MCS/13/5 |
4 | Estraneo et al., 2010 [11] | VS/UWS—50, MCS—0 | TBI—18, ABI—18, VL—14 | VS/UWS/29/1 | VS/UWS/6/1 |
5 | Estraneo et al., 2013 [12] | VS/UWS—43, MCS—0 | ABI—43 | VS/UWS/19/2 | VS/UWS/9/2 |
6 | Steppacher et al., 2014 [13] | VS/UWS—59, MCS—43 | Not specified | VS/UWS + MCS/29/2 | VS/UWS + MCS/12/2 |
7 | Baricich et al., 2017 [14] | VS/UWS—49, MCS—0 | ABI—24, TBI—12, VL—11 | VS/UWS/20/4 | VS/UWS/6/4 |
8 | Aidinoff et al., 2017 [15] | VS/UWS—206, MCS—0 | TBI—154, ABI—14, VL—30, Other—8 | VS/UWS/139/1 VS/UWS/107/2 VS/UWS/105/3 | VS/UWS/111/3 |
9 | Faugeras et al., 2017 [16] | VS/UWS—33, MCS—34 | TBI—13, ABI—19, Other—35 | VS/UWS/5/0.5–3 MCS/20/0.5–3 | No data available |
10 | Yelden et al., 2017 [17] | VS/UWS—27, MCS—7 | ABI—15, TBI—6, VL—13 | No data available | VS/UWS + MCS/11/2 - 16 |
11 | Pascarella et al., 2018 [18] | VS/UWS—37, MCS—16 | TBI—12, ABI—11, VL—30 | VS/UWS + MCS/37/6 | VS/UWS + MCS/17/6 |
12 | Estraneo et al., 2019 [19] | VS/UWS—159, MCS—57 | VL—96, ABI—71, TBI—49 | VS/UWS/131/1 VS/UWS/105/2 VS/UWS/92/3 MCS/41/1 MCS/34/2 MCS/32/3 | VS/UWS/35/1 VS/UWS/8/2 VS/UWS/0/3 MCS/26/1 MCS/1/2 MCS/1/3 |
13 | Chen et al., 2020 [20] | VS/UWS—52, MCS—31 | ABI—10, TBI—35, VL—48 | VS/UWS + MCS/7/1 | VS/UWS + MCS/33/3 |
14 | Estraneo et al., 2020 [21] | VS/UWS—71 MCS—76 | ABI—36, TBI—55, VL—56 | VS/UWS/60/0.5 MCS/72/0.5 | VS/UWS + MCS/72/0.5 |
Mean (Median) Age | 44.99 ± 15.69 (43 (32, 59) | |||
---|---|---|---|---|
Sex (Male/Female) | 122/89 | |||
Etiology | Total (Male/Female) | VS/UWS | MCS− | MCS+ |
Anoxia | 53 (26/27) | 40 | 12 | 1 |
TBI | 93 (65/28) | 44 | 25 | 24 |
Vascular lesions | 59 (28/31) | 35 | 16 | 8 |
Other | 6 (3/3) | 4 | 2 | 0 |
Total level of consciousness | 123 | 55 | 33 | |
Mean CRS-R score | 7.34 ± 3.67 | 5.081 ± 1.22 | 8.22 ± 2.2 | 14.33 ± 1.83 |
Level of Consciousness | At 3 Months | At 6 Months | At 12 Months |
---|---|---|---|
Total: 74 | 15 | 22 | 37 |
VS/UWS | 13 | 8 | 20 |
MCS− | 1 | 6 | 11 |
MCS+ | 1 | 4 | 6 |
Coma | 3 | ||
Conscious | 1 |
Level of Consciousness | Improvement (the Level of Consciousness Achieved) (out of Them Died) | Impairment (the Level of Consciousness Achieved) (out of Them Died) | No Change (out of Them Died) |
---|---|---|---|
Total: 211 | 49 (20 in MCS−; 21 in MCS+; 8 conscious) (1) | 5 (2 in coma; 3 in MCS−) (1) | 157 (13) |
VS/UWS | 27 (20 in MCS−; 5 in MCS+; 2 conscious) | 0 | 96 (12) |
MCS− | 17 (16 in MCS+; 1 conscious) (1) | 1 (1 in coma) | 37 (1) |
MCS+ | 5 (5 conscious) | 4 (1 in coma; 3 in MCS−) (1) | 24 |
Level of Consciousness | Improvement (the Level of Consciousness Achieved) (out of Them Died) | Impairment (the Level of Consciousness Achieved) (out of Them Died) | No Change (out of Them Died) |
---|---|---|---|
Total: 196 | 32 (15 in MCS−; 12 in MCS+; 5 conscious) (3) | 5 (2 in coma; 2 in MCS−; 1 in VS/UWS) (2) | 159 (17) |
VS/UWS | 18 (15 in MCS−; 3 in MCS+) (1) | 1 (1 in coma) (1) | 65 (8) |
MCS− | 10 (9 in MCS+, 1 conscious) (2) | 1 (1 in VS/UWS) | 48 (5) |
MCS+ | 4 (4 conscious) | 3 (1 in coma, 2 in MCS−) (1) | 37 (3) |
Coma | 1 (1) | ||
Conscious | 8 |
Level of Consciousness | Improvement (the Level of Consciousness Achieved) (out of Them Died) | Impairment (the Level of Consciousness Achieved) (out of Them Died) | No Change (out of Them Died) |
---|---|---|---|
Total: 174 | 14 (2 in MCS−; 6 in MCS+; 6 conscious) (4) | 1 (1 in VS/UWS) (1) | 159 (32) |
VS/UWS | 5 (2 in MCS−; 2 in MCS+; 1 conscious) (2) | 53 (19) | |
MCS− | 6 (4 in MCS+; 2 conscious) (2) | 53 (11) | |
MCS+ | 3 (3 conscious) | 1 (in VS/UWS) (1) | 41 (2) |
Coma | |||
Conscious | 12 |
Etiology | C, init | N, init | C, 3 m | N, 3 m | D, 3 m | C, 6 m | N, 6 m | D, 6 m | C, 12 m | N, 12 m | D, 12 m |
---|---|---|---|---|---|---|---|---|---|---|---|
ABI | 1 | 52 | 3 (+2) | 43 (−9) | 7 | 5 (+2) | 36 (−7) | 12 (+5) | 5 | 24 (−12) | 24 (+12) |
TBI | 24 | 69 | 31 (+7) | 61 (−8) | 1 | 33 (+2) | 55 (−6) | 5 (+4) | 37 (+4) | 34 (−21) | 22 (+17) |
VL | 8 | 51 | 18 (+10) | 36 (−15) | 5 | 18 | 24 (−12) | 17 (+12) | 17 (+2) | 18 (−6) | 24 (+7) |
Other | 0 | 6 | 0 | 4 (−2) | 2 | 1 (+1) | 2 (−2) | 3 (+1) | 4 (+3) | 2 | 4 (+1) |
Factor | Reference | β | p | OR (95% CI) |
---|---|---|---|---|
Age | –0.05 | <0.001 | 0.94 (0.92–0.97) | |
Gender (M) | F | –0.17 | 0.61 | 0.84 (0.43–1.63) |
Etiology (Traumatic) | Non-Traumatic | –0.12 | 0.74 | 0.88 (0.42–1.84) |
Status (Non-Communicating) | Communicating | –0.65 | 0.47 | 0.52 (0.08–3.2) |
CRS-R | 0.25 | <0.001 | 1.29 (1.08–1.53) |
Factor | Reference | β | p | OR (95% CI) |
---|---|---|---|---|
Age | 0.01 | 0.26 | 1.02 (0.99–1.04) | |
Gender (M) | F | 0.12 | 0.77 | 1.13 (0.49–2.63) |
Etiology (Traumatic) | Non-Traumatic | –0.47 | 0.29 | 0.62 (0.25–1.51) |
CRS-R | –0.13 | 0.05 | 0.88 (0.77–1.00) |
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Nekrasova, J.; Kanarskii, M.; Borisov, I.; Pradhan, P.; Shunenkov, D.; Vorobiev, A.; Smirnova, M.; Pasko, V.; Petrova, M.V.; Luginina, E.; et al. One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness. Brain Sci. 2021, 11, 651. https://doi.org/10.3390/brainsci11050651
Nekrasova J, Kanarskii M, Borisov I, Pradhan P, Shunenkov D, Vorobiev A, Smirnova M, Pasko V, Petrova MV, Luginina E, et al. One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness. Brain Sciences. 2021; 11(5):651. https://doi.org/10.3390/brainsci11050651
Chicago/Turabian StyleNekrasova, Julia, Mikhail Kanarskii, Ilya Borisov, Pranil Pradhan, Denis Shunenkov, Alexey Vorobiev, Maria Smirnova, Vera Pasko, Marina V. Petrova, Elena Luginina, and et al. 2021. "One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness" Brain Sciences 11, no. 5: 651. https://doi.org/10.3390/brainsci11050651
APA StyleNekrasova, J., Kanarskii, M., Borisov, I., Pradhan, P., Shunenkov, D., Vorobiev, A., Smirnova, M., Pasko, V., Petrova, M. V., Luginina, E., & Pryanikov, I. (2021). One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness. Brain Sciences, 11(5), 651. https://doi.org/10.3390/brainsci11050651