Abstract
Prevention and early recognition of critical illness in patients with autoimmune encephalitis (AE) is essential to achieve better outcome. To evaluate risk factors for intensive care unit (ICU) admission and its prognostic impact in patients with AE. A reclassification of patients hospitalized between 2011 and 2016 revealed 17 "definite" and 15 "probable" AE cases. Thirteen patients (41%) developed critical illness and required ICU admission. The underlying conditions were intractable seizures or status epilepticus (54%), altered mental state (39%), and respiratory failure (8%). ICU admission was associated with longer time from first symptoms to hospitalization (p = 0.046). Regression analysis revealed that anemia on hospital admission and definite diagnosis of AE was associated with a higher risk of acquiring critical illness. At last follow-up after a median of 31 months (range 2.5-52.4), seven patients had died (23%) and 63% had a good outcome [modified Rankin Scale (mRS) 0-3]. Anemia was associated with poor prognosis (p = 0.021), whereas development of critical illness did not impact mortality and functional outcome. We confirmed the need for ICU care in a subgroup of patients and the prevailing objective is improved seizure control, and definite diagnosis of AE and anemia were identified as risk factors for development of critical illness. However, prognosis was not affected by ICU admission.
Highlights
Autoimmune encephalitis (AE) refers to a group of heterogeneous immune-mediated disorders of the central nervous system
We did not identify differences with regard to comorbidities, immunotherapies, and time to these treatments, CSF profile and demographics except the higher rate of anemia among patients with poor outcome (p = 0.021), as shown in Table S2 in Supplementary Material. In this retrospective chart review, we studied 32 patients with AE treated at a tertiary care hospital over the period of 2011–2016 and aimed to identify risk factors for the development of lifethreatening conditions requiring intensive care unit (ICU) admission
The high disease burden related to AE was reflected by the need for ICU care in almost half of the subjects in this cohort, as well as a case fatality rate of 23% and poor functional long-term outcome in 37% of study patients
Summary
Autoimmune encephalitis (AE) refers to a group of heterogeneous immune-mediated disorders of the central nervous system. This emerging entity is characterized by the frequent detection of antibodies directed against proteins and/or receptors on the brain cell surface or intracellular antigens [such. Critical Illness in AE as Hu or Ma2, and less frequently collapsin response mediator protein 5 (CV2/CRMP5) and amphyphysin]. AE is assumed to comprise about 20% or more of all adult encephalitis cases [1]. It must be assumed that the latter group comprised additional AE cases [4]. Prevention and early recognition of critical illness in patients with autoimmune encephalitis (AE) is essential to achieve better outcome.
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