Prognostic factors of prolonged disorder of consciousness after stroke: A single centre retrospective study

Abstract

Background

Stroke is a common disease in neurology, which often causes prolonged disorder of consciousness (pDOC) and brings a heavy burden to the patient's family and society. This study aims to explore the epidemiological factors of pDOC after stroke and the factors affecting the outcome of consciousness.

Method

The patients that admitted in Tianjin Huanhu Hospital from January 2019 to December 2021 and met the inclusion criteria were selected. Descriptive statistics was initially performed on the relevant factors of the stroke group, and statistical analysis was subsequently performed. Finally, to judge the sensitivity and specificity of the significant factors to the prediction of outcome, the receiver operating characteristic (ROC) curve of the participants was used.

Result

The statistical results showed that the location of brain injury (λ² = 7.550, P = 0.023), cerebral hernia (λ² = 7.534, P = 0.006), and Glasgow Coma Scale (GCS) score at onset (t = −2.479, P = 0.017) were statistically significant indicators in the improvement of consciousness in patients with pDOC after stroke. The ROC curve showed that the sensitivity and specificity of predicting the outcome of brain injury site (area under the curve [AUC] = 0.766, 95% confidence interval [CI]: 0.708–0.824) were 0.50 and 0.90, respectively, and that of cerebral hernia (AUC = 0.663, 95% CI: 0.594–0.732) were 0.73 and 0.60, respectively. The GCS score (AUC = 0.660, 95% CI: 0.596–0.724) predicted the outcome with sensitivity and specificity of 0.35 and 0.92, respectively.

Conclusion

The incidence rate of pDOC after stroke in men was higher than that in women, and the improvement rate in the consciousness level was significantly higher than that of ischemic–hypoxic encephalopathy. However, the improvement rate of the consciousness level in patients with pDOC after stroke was not related to age and gender. Cerebral hernia occurred at the time of onset, stroke occurred in the brainstem, and the low GCS score at the time of onset was significantly associated with the poor prognosis of consciousness level.