title: Morfeo Study II: Clinical Course and Complications in Patients With Long-Term Disorders of Consciousness.
abstract: BACKGROUND
  The life expectancy of patients with disorders of consciousness (DOCs) is ever-increasing, but little is known about their clinical course over late stages. Several issues (premorbid conditions, complications and pressure sores) are to be considered for their effect on clinical outcome, risk of death and recovery of functional performance. Unfortunately, in late stages of long-term rehabilitation, these aspects are still more neglected than in acute and postacute stages. The aim of this study was to investigate the clinical course and the complications of patients in the late stages of DOCs and to explore the relationship between mortality and specific biomarkers.
  
  
  METHODS
  A total of 112 patients, admitted over 10 years in a dedicated ward, were retrospectively studied. Sociodemographic data, preadmission and inpatient clinical features were collected. Disability Rating Scale scores, complications including pressure sores and blood markers were assessed monthly. Data were analyzed through descriptive statistics and correlations using SPSS.
  
  
  RESULTS
  Most patients were men older than 50 years with a nontraumatic etiology and a history of hypertension (42.86%). The most common complication was pneumonia (76.79%). No association was found between sex and mortality or between etiology and mortality (P > 0.05). Mortality correlated significantly with sepsis (ρ = 0.253), albumin (ρ = -0.558), hemoglobin (ρ = -0.354) and white blood cells (ρ = 0.243). Only 42% of patients remained unchanged at Disability Rating Scale evaluation.
  
  
  CONCLUSIONS
  These data confirmed that DOCs are not static conditions and they require ongoing monitoring and assessment of clinical status, level of consciousness and laboratory biomarkers.
authors.affiliation: Santa Viola Hospital, Bologna, Italy. Electronic address: romaniello.caterina@gmail.com.
authors.forename: Caterina
authors.initials: C
authors.lastname: Romaniello
authors.affiliation: Santa Viola Hospital, Bologna, Italy.
authors.forename: Erik
authors.initials: E
authors.lastname: Bertoletti
authors.affiliation: Santa Viola Hospital, Bologna, Italy.
authors.forename: Nunzio
authors.initials: N
authors.lastname: Matera
authors.affiliation: Clinical Psychology Service, Villa Bellombra Rehabilitation Hospital, Bologna, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Farinelli
authors.affiliation: Santa Viola Hospital, Bologna, Italy; Villa Bellombra Rehabilitation Hospital, Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pedone
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D000070642:Brain Injuries, Traumatic / Q000150:complications; D002561:Cerebrovascular Disorders / Q000150:complications; D015897:Comorbidity; D003244:Consciousness Disorders / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D003668:Pressure Ulcer / Q000453:epidemiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin
keywords: Albumin; Complications; Etiology; Hemoglobin; Pressure sores