Prognostic factors of prolonged disorders of consciousness after stroke

LI Zhong-zhen; YAN Chao; WU Yu-zhang; WNAG Yan-gang; CHENG Yi-feng; FENG Ke-ke; Wang Zhong-peng; ZHANG Guo-bin; YIN Shao-ya

doi:10.13798/j.issn.1009-153X.2025.04.005

Abstract：Objective To investigate the factors associated with the prognosis of patients with post-stroke prolonged disorders of consciousness(pDoC).Methods The clinical data from 53 patients with post-stroke pDoC admitted between January 2019 and December 2021 were retrospectively analyzed.The Coma Recovery Scale-Revised(CRS-R)was used to assess consciousness levels upon admission and at 6 months post-admission;an increase in CRS-R score indicated improvement in consciousness level.Results Among the 53 patients,consciousness improved in 36 cases at 6 months post-admission,including 19 who emerged from the minimally conscious state;no improvement was observed in 17 cases,including 6 deaths.Univariate analysis showed that stroke location,occurrence of brain herniation after onset,and Glasgow Coma Scale(GCS)score at onset were associated with consciousness improvement at 6 months in post-stroke pDoC patients(P<0.05).Multivariate logistic regression analysis identified brain herniation at onset(OR=10.335;95%CI:1.958～54.474;P=0.006),brainstem stroke(OR=10.164;95%CI:1.488～69.451;P=0.018),and low GCS score at onset(OR=0.343;95%CI:0.129～0.912;P=0.032)as independent risk factors for no improvement in consciousness at 6 months.ROC curve analysis for predicting no improvement at 6 months showed:brainstem stroke(AUC=0.694;95%CI:0.539～0.850),sensitivity 0.806,specificity 0.529;brain herniationbrain herniation at onset(AUC=0.700;95%CI:0.546～0.854),sensitivity 0.694,specificity 0.706;GCS score at onset(AUC=0.764;95%CI:0.640～0.888),sensitivity 0.833,specificity 0.647.Conclusion Brain herniation after onset,brainstem stroke,and low GCS score at onset are significantly associated with poor 6-month consciousness outcomes in post-stroke pDoC patients.