RT Journal Article
SR Electronic
T1 Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e514
DO 10.1212/NXI.0000000000000514
VO 6
IS 1
A1 Schubert, Julia
A1 Brämer, Dirk
A1 Huttner, Hagen B.
A1 Gerner, Stefan T.
A1 Fuhrer, Hannah
A1 Melzer, Nico
A1 Dik, Andre
A1 Prüss, Harald
A1 Ly, Lam-Than
A1 Fuchs, Kornelius
A1 Leypoldt, Frank
A1 Nissen, Gunnar
A1 Schirotzek, Ingo
A1 Dohmen, Christian
A1 Bösel, Julian
A1 Lewerenz, Jan
A1 Thaler, Franziska
A1 Kraft, Andrea
A1 Juranek, Aleksandra
A1 Ringelstein, Marius
A1 Sühs, Kurt-Wolfram
A1 Urbanek, Christian
A1 Scherag, André
A1 Geis, Christian
A1 Witte, Otto W.
A1 Günther, Albrecht
A1 ,
YR 2019
UL http://nn.neurology.org/content/6/1/e514.abstract
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