PDF(Pubmed)
Abstract：
OBJECTIVE: Assessing recovery potential in patients with disorders of consciousness (DoC) is pivotal for guiding clinical and ethical decisions. We conducted a mega-analysis of individual patient data to understand (1) if a time threshold exists, beyond which regaining consciousness is almost impossible, and (2) how recovery varies based on factors such as diagnosis, etiology, age, sex, and neuropsychological status.
METHODS: A systematic literature search revealed a total of 3290 patients. In this sample, we performed a Cox proportional hazards analysis for interval censored data.
RESULTS: We observed a late saturation of probability to regain consciousness in Kaplan-Meier curves, and the annual rate of recovery was remarkably stable, in that approximately 35% of patients regained consciousness per year. Patients in minimally conscious state (MCS) recovered more frequently than patients in unresponsive wakefulness syndrome (UWS). No significant difference was observed between the recovery dynamics of MCS subgroups: MCS+ and MCS-. Patients with hypoxic brain lesions showed worse recovery rate than patients with traumatic brain injury and patients with vascular brain lesions, while the latter two categories did not differ from each other. Male patients had moderately better chance to regain consciousness. While younger UWS patients recovered more frequently than older patients, it was not the case in MCS.
CONCLUSIONS: Our findings highlight the necessity for neurologists to exercise caution when making negative predictions in individual cases, challenge traditional beliefs regarding recovery timelines, and underscore the importance of conducting detailed and prolonged assessments to better understand recovery prospects in DoC.
METHODS: A systematic literature search revealed a total of 3290 patients. In this sample, we performed a Cox proportional hazards analysis for interval censored data.
RESULTS: We observed a late saturation of probability to regain consciousness in Kaplan-Meier curves, and the annual rate of recovery was remarkably stable, in that approximately 35% of patients regained consciousness per year. Patients in minimally conscious state (MCS) recovered more frequently than patients in unresponsive wakefulness syndrome (UWS). No significant difference was observed between the recovery dynamics of MCS subgroups: MCS+ and MCS-. Patients with hypoxic brain lesions showed worse recovery rate than patients with traumatic brain injury and patients with vascular brain lesions, while the latter two categories did not differ from each other. Male patients had moderately better chance to regain consciousness. While younger UWS patients recovered more frequently than older patients, it was not the case in MCS.
CONCLUSIONS: Our findings highlight the necessity for neurologists to exercise caution when making negative predictions in individual cases, challenge traditional beliefs regarding recovery timelines, and underscore the importance of conducting detailed and prolonged assessments to better understand recovery prospects in DoC.
摘要：
目的：评估意识障碍（DoC）患者的恢复潜力对于指导临床和伦理决策至关重要。我们对单个患者数据进行了大规模分析，以了解(1)是否存在时间阈值，除此之外，恢复意识几乎是不可能的，和(2)恢复如何根据因素变化，如诊断，病因学,年龄,性别,和神经心理状态。
方法：系统文献检索显示共3290例患者。在这个样本中，我们对间隔删失数据进行了Cox比例风险分析.
结果：我们观察到在Kaplan-Meier曲线中恢复意识的概率的晚期饱和，年回收率非常稳定，每年约35%的患者恢复意识。处于最低意识状态（MCS）的患者比处于无反应的觉醒综合征（UWS）的患者恢复的频率更高。MCS亚组的恢复动力学之间没有观察到显着差异：MCS和MCS-。缺氧性脑损伤患者的恢复率比创伤性脑损伤患者和血管性脑损伤患者差，而后两类则没有区别。男性患者恢复意识的机会中等。虽然年轻的UWS患者比老年患者恢复更频繁，MCS的情况并非如此。
结论：我们的研究结果强调了神经科医师在个别情况下做出负面预测时要谨慎行事的必要性。挑战关于恢复时间表的传统信念，并强调进行详细和长期评估以更好地了解DoC恢复前景的重要性。
方法：系统文献检索显示共3290例患者。在这个样本中，我们对间隔删失数据进行了Cox比例风险分析.
结果：我们观察到在Kaplan-Meier曲线中恢复意识的概率的晚期饱和，年回收率非常稳定，每年约35%的患者恢复意识。处于最低意识状态（MCS）的患者比处于无反应的觉醒综合征（UWS）的患者恢复的频率更高。MCS亚组的恢复动力学之间没有观察到显着差异：MCS和MCS-。缺氧性脑损伤患者的恢复率比创伤性脑损伤患者和血管性脑损伤患者差，而后两类则没有区别。男性患者恢复意识的机会中等。虽然年轻的UWS患者比老年患者恢复更频繁，MCS的情况并非如此。
结论：我们的研究结果强调了神经科医师在个别情况下做出负面预测时要谨慎行事的必要性。挑战关于恢复时间表的传统信念，并强调进行详细和长期评估以更好地了解DoC恢复前景的重要性。
