Exploring sex hormones as potential prognostic biomarkers in prolonged disorders of consciousness: a sex-specific retrospective study

Background Patients with prolonged disorders of consciousness (pDoC) present significant clinical challenges, directly influencing awakening strategies and the allocation of healthcare resources. This study aimed to evaluate serum sex hormone levels in pDoC patients and assess their potential for predicting clinical outcomes. Methods This retrospective study initially screened 142 patients with prolonged disorders of consciousness (pDoC) admitted between January 2023 and January 2025. After applying exclusion criteria, a final cohort of 119 patients (77 males and 42 females) was included for analysis. Within 1 week of enrollment, the Chinese Coma Recovery Scale-Revised (CRS-R) score and serum sex hormone levels were assessed. Outcomes were evaluated at 6 months using the Glasgow Outcome Scale–Extended (GOS-E) and classified as good outcome(GOSE score≥4) or poor outcome(GOSE score Results Among male patients, the good outcome group showed higher testosterone levels ( p = 0.02) and a trend toward lower prolactin levels ( p = 0.06) compared to the poor outcome group. In female patients, the good outcome group had lower levels of prolactin, follicle-stimulating hormone, and luteinizing hormone ( p p = 0.02), though this did not survive Bonferroni correction (P_bonf = 0.10). Prolactin and other sex hormones were not independent predictors in either sex. Receiver operating characteristic (ROC) analysis demonstrated that testosterone alone yielded an area under the curve (AUC) of 0.656 (95% CI: 0.532–0.781), with minimal improvement after etiology adjustment (AUC = 0.691, 95% CI: 0.573–0.809; p = 0.45). Conclusion Serum testosterone showed exploratory, hypothesis-generating associations with favorable outcomes in male pDoC patients. However, these findings did not survive correction for multiple testing, and the predictive performance was modest. Sex hormone levels did not demonstrate clear prognostic value in female patients. These preliminary observations underscore the need for larger, prospective studies with standardized endocrine protocols to validate the potential role of sex hormones as prognostic biomarkers in pDoC.