Risk Factors for Mortality in Anti-NMDAR, Anti-LGI1, and Anti-GABABR Encephalitis.

Rui Zhong,Hanyu Zhang,Qingling Chen,Xinyue Zhang,Weihong Lin

doi:10.3389/fimmu.2022.845365

Abstract

ObjectiveWe aimed to investigate the mortality rate and identify the predictors of death in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis.MethodsPatients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis were recruited from the Neurology Department of the First Hospital of Jilin University from March 2015 to November 2021. The primary outcome variable was a binary variable of death vs. survival. The potential risk factors for mortality were evaluated. The mortality rates were determined, and the independent predictors of death were identified using multivariable logistic regression analysis.ResultsA total of 100 hospitalized patients with anti-NMDAR, anti-LGI1, or anti-GABABR encephalitis were included in the final analysis. Fifteen patients (15%) died during a median follow-up period of 18 months. The mortality rates were 10% for anti-NMDAR encephalitis, 2.8% for anti-LGI1 encephalitis, and 41.7% for anti-GABABR encephalitis. The multivariable analysis results showed that older age at onset [adjusted odds ratio (OR) = 1.017, 95% confidence interval (CI) = 1.009–1.136; p = 0.023] was independently associated with an increased risk of death. Antibody type was also associated with mortality. Patients with anti-GABABR encephalitis had 13.458-fold greater odds of dying than patients with anti-LGI1 encephalitis (adjusted OR = 13.458, 95% CI = 1.270–142.631; p = 0.031).ConclusionThe general mortality rate of anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis was 15%. Age at onset and type of autoimmune encephalitis antibody were independent predictors of death in these patients.

Highlights

In recent years, the group of neuroinflammatory diseases known as autoimmune encephalitis (AE) has been recognized to encompass an increasingly wide and diverse range of pathological processes associated with the presence of antibodies against neuronal intracellular proteins, synaptic receptors, ion channels, and/or neuronal surface proteins [1–3]
The mortality rate of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis as reported by prior studies ranged from 5% to 11.46%, which was lower than that of anti-g-aminobutyric acid B receptor (GABABR) encephalitis [7, 11, 12]
100 hospitalized patients with anti-NMDAR, anti-leucine-rich glioma-inactivated protein 1 (LGI1), and anti-GABABR encephalitis were included in the final analysis after 10 patients were excluded based on the exclusion criteria

Summary

Introduction

The group of neuroinflammatory diseases known as autoimmune encephalitis (AE) has been recognized to encompass an increasingly wide and diverse range of pathological processes associated with the presence of antibodies against neuronal intracellular proteins, synaptic receptors, ion channels, and/or neuronal surface proteins [1–3]. Mortality in AE Patients g-aminobutyric acid B receptor (GABABR), and anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis [3, 4]. Mortality in AE patients has received little attention [10, 11]. Hong and her colleagues reported high mortality in patients with anti-GABABR encephalitis; 32.1% of these patients died during the disease course [10]. The mortality rate of anti-NMDAR encephalitis as reported by prior studies ranged from 5% to 11.46%, which was lower than that of anti-GABABR encephalitis [7, 11, 12]. The following clinical variables were identified as risk factors for death: number of complications, intensive care unit (ICU) admission, length of ICU stay, age at onset, presence of a tumor, and deep venous thrombosis [10, 11, 13]

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Conclusion