Abstract
Objective: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an acute form of encephalitis of autoimmune etiology. We aimed to evaluate the risk factors that predicted the need for mechanical ventilation during the acute phase of anti-NMDAR encephalitis through an analysis of the clinical characteristics and biochemical test results of the patients with anti-NMDAR encephalitis.Methods: In this retrospective study, patients who primarily presented with anti-NMDAR encephalitis and exhibited anti-NMDAR antibody positivity in the cerebrospinal fluid (CSF) between November 2015 and February 2020 were included. Data on the clinical characteristics, biochemical test results, and treatment methods selected for the patients were collected for the analysis of factors predicting the need for mechanical ventilation.Results: Thirty-one patients with a median age of onset of 31 years (inter-quartile range: 21–48 years) were included in this study, of which 15 were male (48.4%). Psychosis (23, 74.2%), seizures (20, 64.5%), and memory deficit (20, 64.5%) were the most common clinical manifestations. At admission, 17 patients (54.8%) presented with pyrexia, of which 12 (38.7%) had a body temperature ≥38°C, and six patients (19.4%) presented with central hypoventilation. All patients received first-line therapy (glucocorticoids, intravenous immunoglobulin, or plasmapheresis alone or combined), whereas two patients (6.5%) received rituximab, a second-line agent, as well. Seven patents required mechanical ventilation. Results of univariate logistic regression analysis revealed that body temperature ≥38°C [odds ratio (OR) = 18, 95% confidence interval (CI): 1.79–181.31, P < 0.05] and central hypoventilation at admission (OR = 57.50, 95% CI: 4.32–764.89, P < 0.05) were the risk factors for mechanical ventilation. Multivariate logistic regression analysis showed that central hypoventilation at admission was the only risk factor predicting the need for mechanical ventilation.Conclusion: Central hypoventilation at admission is a key risk factor for mechanical ventilation during hospitalization in patients with anti-NMDAR encephalitis.
Highlights
Anti-N-methyl-D-aspartate receptorencephalitis is the most common form of autoimmune encephalitis and is associated with autoantibodies against neuronal surface or synaptic antigens [1, 2]
Results of univariate logistic regression analysis revealed that body temperature ≥38◦C [odds ratio (OR) = 18, 95% confidence interval (CI): 1.79–181.31, P < 0.05] and central hypoventilation at admission (OR = 57.50, 95% CI: 4.32–764.89, P < 0.05) were the risk factors for mechanical ventilation
Multivariate logistic regression analysis showed that central hypoventilation at admission was the only risk factor predicting the need for mechanical ventilation
Summary
Anti-N-methyl-D-aspartate receptor (anti-NMDAR)encephalitis is the most common form of autoimmune encephalitis and is associated with autoantibodies against neuronal surface or synaptic antigens [1, 2]. Since the first report of anti-NMDAR encephalitis in 2007 [3], the number of confirmed diagnoses has increased rapidly with the widespread application of detection methods. Differences in the clinical characteristics and treatment strategies for anti-NMDAR encephalitis among patients of different races and countries have been reported [4]. A study conducted on patients of Peking Union Medical College Hospital revealed that 20% of patients with anti-NMDAR encephalitis required mechanical ventilation [5]. The reported mortality rates of anti-NMDAR encephalitis range from 2.7 to 11.45% [6]. Early treatment, and the patient not requiring admission to the intensive care unit (ICU) are the predictors of good prognosis [7]. We retrospectively reviewed the data of patients, who had been referred to the Neurology
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