本文由小咖机器人翻译整理

期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-03019-1

摘要内容如下：

准确预测急性脑损伤无反应患者的功能结果是一项医学、科学和伦理挑战。这项前瞻性研究评估了结合不同数量的行为、神经影像和电生理标记物的多模式方法如何影响结果预测的性能。我们分析了2009年至2021年间入住三级神经重症监护病房的349例患者的数据，将预后分为良好、不确定或差，并使用格拉斯哥预后扩展量表（GOS-E，水平范围为1至8，水平越高表示预后越好）将这些预测与观察到的结果进行比较。在排除了停止维持生命治疗以减轻自我实现预言偏差的病例后，我们的研究结果显示，与预后较差或不确定的病例相比，预后良好的病例与较好的一年功能结果相关（较高GOS-E的共同优势比（95%CI）：OR=14.57（5.70-40.32），P<0.001；和2.9（1.56-5.45），P<0.001）。此外，增加评估模式的数量可降低不确定性（OR=0.35（0.21-0.59），P<0.001）并提高预后准确性（OR=2.72（1.18-6.47），P=0.011）。我们的研究结果强调了多模式评估在提高神经预后精确度方面的价值，从而为急性脑损伤患者的临床决策过程提供了坚实的基础。ClinicalTrials.gov注册：NCT04534777。

英文原文如下：

Abstracts

Accurately predicting functional outcomes for unresponsive patients with acute brain injury is a medical, scientific and ethical challenge. This prospective study assesses how a multimodal approach combining various numbers of behavioral, neuroimaging and electrophysiological markers affects the performance of outcome predictions. We analyzed data from 349 patients admitted to a tertiary neurointensive care unit between 2009 and 2021, categorizing prognoses as good, uncertain or poor, and compared these predictions with observed outcomes using the Glasgow Outcome Scale-Extended (GOS-E, levels ranging from 1 to 8, with higher levels indicating better outcomes). After excluding cases with life-sustaining therapy withdrawal to mitigate the self-fulfilling prophecy bias, our findings reveal that a good prognosis, compared with a poor or uncertain one, is associated with better one-year functional outcomes (common odds ratio (95% CI) for higher GOS-E: OR = 14.57 (5.70-40.32), P < 0.001; and 2.9 (1.56-5.45), P < 0.001, respectively). Moreover, increasing the number of assessment modalities decreased uncertainty (OR = 0.35 (0.21-0.59), P < 0.001) and improved prognostic accuracy (OR = 2.72 (1.18-6.47), P = 0.011). Our results underscore the value of multimodal assessment in refining neuroprognostic precision, thereby offering a robust foundation for clinical decision-making processes for acutely brain-injured patients. ClinicalTrials.gov registration: NCT04534777 .

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