A dynamic model to predict long-term outcomes in patients with prolonged disorders of consciousness

Abstract

PURPOSE: It is important to predict the prognosis of patients with prolonged disorders of consciousness (DOC). This study established and validated a nomogram and corresponding web-based calculator to predict outcomes for patients with prolonged DOC. METHODS: All data were obtained from the First Affiliated Hospital of Nanchang University and the Shangrao Hospital of Traditional Chinese Medicine. Predictive variables were identified by univariate and multiple logistic regression analyses. Receiver operating characteristic curves, calibration curves, and a decision curve analysis (DCA) were utilized to assess the predictive accuracy, discriminative ability, and clinical utility of the model, respectively. RESULTS: Independent prognostic factors, such as age, Glasgow coma scale score, state of consciousness, and brainstem auditory-evoked potential grade were integrated into a nomogram. The model demonstrated good discrimination in the training and validation cohorts, with area-under-the-curve values of 0.815 (95% confidence interval [CI]: 0.748-0.882) and 0.805 (95% CI: 0.727-0.883), respectively. The calibration plots and DCA demonstrated good model performance and clear clinical benefits in both cohorts. CONCLUSIONS: Based on our nomogram, we developed an effective, simple, and accurate model of a web-based calculator that may help individualize healthcare decision-making. Further research is warranted to optimize the system and update the predictors.