Abstract
Objectives
Although laboratory parameters have long been recognized as indicators of outcome of traumatic brain injury (TBI), it remains a challenge to predict the recovery of disorder of consciousness (DOC) in severe brain injury including TBI. Recent advances have shown an association between alterations in brain connectivity and recovery from DOC. In the present study, we developed a prognostic model of DOC recovery via a combination of laboratory parameters and resting-state functional magnetic resonance imaging (fMRI).
Methods
Fifty-one patients with DOC (age = 52.3 ± 15.2 y, male/female = 31/20) were recruited from Hangzhou Hospital of Zhejiang CAPR and were sub-grouped into conscious (n = 34) and unconscious (n = 17) groups based upon their Glasgow Outcome Scale-Extended (GOS-E) scores at 12-month follow-ups after injury. Resting-state functional connectivity, network nodal measures (centrality), and laboratory parameters were obtained from each patient and served as features for support vector machine (SVM) classifications.
Results
We found that functional connectivity was the most accurate single-domain model (ACC: 70.1% ± 4.5%, P = 0.038, 1000 permutations), followed by degree centrality, betweenness centrality, and laboratory parameters. The stacked multi-domain prognostic model (ACC: 73.4% ± 3.1%, P = 0.005, 1000 permutations) combining all single-domain models yielded a significantly higher accuracy compared to that of the best-performing single-domain model (P = 0.002).
Conclusion
Our results suggest that laboratory parameters only contribute to the outcome prediction of DOC patients, whereas combining information from neuroimaging and clinical parameters may represent a strategy to achieve a more accurate prognostic model, which may further provide better guidance for clinical management of DOC patients.
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Funding
This article was supported by grants from the National Natural Science Foundation of China (81870817), National Key R&D Program of China (2018YFA0701400), and the Fundamental Research Funds for the Central Universities +2019-XZZX-001-01-02. Y. S. was additionally supported by the National Natural Science Foundation of China (81801785) and the Fundamental Research Funds for the Central Universities (2019FZJD005, 2020FZZX001-05).
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This study was approved by the Ethics Committee of the First Affiliated Hospital within the School of Medicine at Zhejiang University, and written informed consents in accordance with the Declaration of Helsinki were obtained from the legal guardians of the included patients.
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Yu, Y., Meng, F., Zhang, L. et al. A multi-domain prognostic model of disorder of consciousness using resting-state fMRI and laboratory parameters. Brain Imaging and Behavior 15, 1966–1976 (2021). https://doi.org/10.1007/s11682-020-00390-8
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DOI: https://doi.org/10.1007/s11682-020-00390-8