Prediction of emergence from the minimally conscious state at 6 months using acute-phase clinical and event-related potential indicators in patients with prolonged disorders of consciousness: a single-center retrospective cohort study
- 1Department of Neurosurgery, Zhujiang Hospital of Southern Medical University, The National Key Clinical Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Engineering Technology Research Center of Education Ministry of China, Southern Medical University
- 2The Second Affiliated Hospital, Department of Neuromedicine Center, Hengyang Medical School, University of South China
- 3Department of Neurosurgery, The Seventh Affiliated Hospital, Southern Medical University
Abstract
Objective: To identify acute-phase predictors of long-term outcome in patients with disorders of consciousness (DoC) and establish a multimodal prediction model.
Methods: This retrospective study enrolled 227 patients with prolonged DoC at the Second Affiliated Hospital of the University of South China between August 2019 and December 2025. The primary endpoint was emergence from the minimally conscious state (eMCS) at 6 months after onset, defined as functional communication or functional use of objects on the Coma Recovery Scale-Revised (CRS-R), which was assessed at 1, 3 and 6 months after onset. Clinical, imaging and neurophysiological acute-phase data (≤28 days after onset) were collected. Variables significant in univariate analysis entered multivariable logistic regression; clinical, electrophysiological and combined models were compared by the area under the receiver operating characteristic curve (AUC), calibration and clinical utility, and the final model was presented as a nomogram.
Results: Univariate screening identified age, acute-phase FOUR score, MMN and P300 amplitudes, cerebral herniation, etiology, hydrocephalus and st-SCS surgery (all p < 0.05); age, etiology, FOUR score and Fz P300 amplitude remained independent in multivariable analysis. Discrimination was acceptable for the clinical (AUC = 0.745, 95% CI 0.681–0.809) and multimodal (AUC = 0.772, 95% CI 0.711–0.832) models, but not significantly different (ΔAUC = 0.027, DeLong test p = 0.115); after bootstrap correction the multimodal AUC was 0.735, with adequate calibration (Hosmer-Lemeshow p = 0.634). Adding ERP measures improved reclassification relative to the clinical model (continuous NRI = 0.317, 95% CI 0.062–0.572, p = 0.015; IDI = 0.039, 0.014–0.065, p = 0.003). Performance did not differ between TBI and non-TBI patients (ΔAUC = 0.061, p = 0.346), although these comparisons were underpowered.
Conclusion: Acute-phase FOUR score, age, etiology and the Fz P300 amplitude were independently associated with emergence from the minimally conscious state at 6 months in prolonged DoC. A nine-indicator multimodal model showed acceptable, internally validated discrimination (AUC = 0.772; bootstrap-corrected 0.735) and modestly improved reclassification over clinical variables alone (continuous NRI = 0.317; IDI = 0.039). External validation is required before clinical use.
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BibTeX
@article{cui2026prediction,
title = {{Prediction of emergence from the minimally conscious state at 6 months using acute-phase clinical and event-related potential indicators in patients with prolonged disorders of consciousness: a single-center retrospective cohort study}},
author = {Shenghua Cui and Ping Chen and Jinjin Li and Shuai Cheng and Chenyu Liu and Haiyang Bian and Zhenyu Nie and Yizhao Chen},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1948269},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1948269/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prediction of emergence from the minimally conscious state at 6 months using acute-phase clinical and event-related potential indicators in patients with prolonged disorders of consciousness: a single-center retrospective cohort study
AU - Shenghua Cui
AU - Ping Chen
AU - Jinjin Li
AU - Shuai Cheng
AU - Chenyu Liu
AU - Haiyang Bian
AU - Zhenyu Nie
AU - Yizhao Chen
PY - 2026
DA - 2026/10/28
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1948269
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1948269/full
AB - Objective: To identify acute-phase predictors of long-term outcome in patients with disorders of consciousness (DoC) and establish a multimodal prediction model. Methods: This retrospective study enrolled 227 patients with prolonged DoC at the Second Affiliated Hospital of the University of South China between August 2019 and December 2025. The primary endpoint was emergence from the minimally conscious state (eMCS) at 6 months after onset, defined as functional communication or functional use of objects on the Coma Recovery Scale-Revised (CRS-R), which was assessed at 1, 3 and 6 months after onset. Clinical, imaging and neurophysiological acute-phase data (≤28 days after onset) were collected. Variables significant in univariate analysis entered multivariable logistic regression; clinical, electrophysiological and combined models were compared by the area under the receiver operating characteristic curve (AUC), calibration and clinical utility, and the final model was presented as a nomogram. Results: Univariate screening identified age, acute-phase FOUR score, MMN and P300 amplitudes, cerebral herniation, etiology, hydrocephalus and st-SCS surgery (all p < 0.05); age, etiology, FOUR score and Fz P300 amplitude remained independent in multivariable analysis. Discrimination was acceptable for the clinical (AUC = 0.745, 95% CI 0.681–0.809) and multimodal (AUC = 0.772, 95% CI 0.711–0.832) models, but not significantly different (ΔAUC = 0.027, DeLong test p = 0.115); after bootstrap correction the multimodal AUC was 0.735, with adequate calibration (Hosmer-Lemeshow p = 0.634). Adding ERP measures improved reclassification relative to the clinical model (continuous NRI = 0.317, 95% CI 0.062–0.572, p = 0.015; IDI = 0.039, 0.014–0.065, p = 0.003). Performance did not differ between TBI and non-TBI patients (ΔAUC = 0.061, p = 0.346), although these comparisons were underpowered. Conclusion: Acute-phase FOUR score, age, etiology and the Fz P300 amplitude were independently associated with emergence from the minimally conscious state at 6 months in prolonged DoC. A nine-indicator multimodal model showed acceptable, internally validated discrimination (AUC = 0.772; bootstrap-corrected 0.735) and modestly improved reclassification over clinical variables alone (continuous NRI = 0.317; IDI = 0.039). External validation is required before clinical use.
SN - 1664-2295
ER -