PT  - JOURNAL ARTICLE
AU  - Schubert, Julia
AU  - Brämer, Dirk
AU  - Huttner, Hagen B.
AU  - Gerner, Stefan T.
AU  - Fuhrer, Hannah
AU  - Melzer, Nico
AU  - Dik, Andre
AU  - Prüss, Harald
AU  - Ly, Lam-Than
AU  - Fuchs, Kornelius
AU  - Leypoldt, Frank
AU  - Nissen, Gunnar
AU  - Schirotzek, Ingo
AU  - Dohmen, Christian
AU  - Bösel, Julian
AU  - Lewerenz, Jan
AU  - Thaler, Franziska
AU  - Kraft, Andrea
AU  - Juranek, Aleksandra
AU  - Ringelstein, Marius
AU  - Sühs, Kurt-Wolfram
AU  - Urbanek, Christian
AU  - Scherag, André
AU  - Geis, Christian
AU  - Witte, Otto W.
AU  - Günther, Albrecht
AU  - ,
TI  - Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment
AID  - 10.1212/NXI.0000000000000514
DP  - 2019 Jan 01
TA  - Neurology - Neuroimmunology Neuroinflammation
PG  - e514
VI  - 6
IP  - 1
4099  - http://nn.neurology.org/content/6/1/e514.short
4100  - http://nn.neurology.org/content/6/1/e514.full
SO  - Neurol Neuroimmunol Neuroinflamm2019 Jan 01; 6
AB  - Objective To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE).Methods This study was an observational multicenter registry of consecutively included patients diagnosed with AE requiring Neuro-ICU treatment between 2004 and 2016 from 18 tertiary hospitals. Logistic regression models explored the influence of complications, their management, and diagnostic findings on the dichotomized (0–3 vs 4–6) modified Rankin Scale score at hospital discharge.Results Of 120 patients with AE (median age 43 years [interquartile range 24–62]; 70 females), 101 developed disorders of consciousness, 54 autonomic disturbances, 42 status epilepticus, and 39 severe sepsis. Sixty-eight patients were mechanically ventilated, 85 patients had detectable neuronal autoantibodies, and 35 patients were seronegative. Worse neurologic outcome at hospital discharge was associated with necessity of mechanical ventilation (sex- and age-adjusted OR 6.28; 95% CI, 2.71–15.61) tracheostomy (adjusted OR 6.26; 95% CI, 2.68–15.73), tumor (adjusted OR 3.73; 95% CI, 1.35–11.57), sepsis (adjusted OR 4.54; 95% CI, 1.99–10.43), or autonomic dysfunction (adjusted OR 2.91; 95% CI, 1.24–7.3). No significant association was observed with autoantibody type, inflammatory changes in CSF, or pathologic MRI.Conclusion In patients with AE, mechanical ventilation, sepsis, and autonomic dysregulation appear to indicate longer or incomplete convalescence. Classic ICU complications better serve as prognostic markers than the individual subtype of AE. Increased awareness and effective management of these AE-related complications are warranted, and further prospective studies are needed to confirm our findings and to develop specific strategies for outcome improvement.AE=autoimmune encephalitis; AED=antiepileptic drug; DWI=diffusion-weighted imaging; eCRF=electronic case report form; FDG-PET=fluorodeoxyglucose PET; FLAIR=fluid-attenuated inversion recovery; GENERATE=German Network for Research in Autoimmune Encephalitis; ICU=intensive care unit; IGNITE=Initiative of German Neurointensive Trial Engagement; IQR=interquartile range; mRS=modified Rankin Scale; RE=receptor encephalitis; SE=status epilepticus