Options for ovarian failure and the development of prognostic models for outcomes in patients with different types of chronic disorders of consciousness

Abstract Background. Chronic disorders of consciousness are rare clinical conditions that develop after coma and are accompanied by the restoration of wakefulness without the full restoration of consciousness 28 days or longer after brain damage. The results of a comprehensive examination of patients with different types of ovarian failure, depending on the type of chronic disorders of consciousness, have not been presented in the literature. Studying ovarian function in this population may help identify markers of consciousness recovery. Methods. The study included 30 women aged 18–44 years (mean age: 29 ± 8.2 years). Etiologies of CDC were traumatic (30%) and nontraumatic (70%), including hypoxic injury, postsurgical and postpartum embolism, and infectious causes. The duration of impairment ranged from 1 to 15 months. Most patients had a normal BMI. Neurobiological markers, including BDNF, APO-1, Fas-L, and glutamate, were measured. Results. Hormonal assessments revealed universal ovarian failure, with decreased estradiol levels. Notably, all patients exhibited signs of ovarian failure, with some showing hyperprolactinemia and subclinical hypothyroidism. Vitamin D deficiency was prevalent across the cohort. BDNF levels were within reference ranges in most patients, with no correlation with the state of consciousness. Elevated APO-1 and Fas-L levels were observed in some patients, but no significant differences were found between the groups. The glutamate levels varied, with some exceeding normal ranges, but no consistent pattern emerged. These findings suggest the limited prognostic utility of these biomarkers in predicting consciousness recovery. Conclusions. Three prognostic models for favourable outcomes have been developed on the basis of blood hormone levels (FSH, TSH, AMH, prolactin, and testosterone) and patient age. This study underscores the complexity of hormonal and neurobiological interactions in CDC and highlights the potential role of disconnection within cortical and subcortical networks in ovarian failure. Further research is necessary to elucidate these mechanisms and develop reliable prognostic models for recovery.