Abstract:
RATIONALE:Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients. OBJECTIVES:To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis. METHODS:This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2. MEASUREMENTS AND MAIN RESULTS:Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for <5 vs. >50 cells/mm3; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome. CONCLUSIONS:The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
journal_name
Am J Respir Crit Care Medauthors
de Montmollin E,Demeret S,Brulé N,Conrad M,Dailler F,Lerolle N,Navellou JC,Schwebel C,Alves M,Cour M,Engrand N,Tonnelier JM,Maury E,Ruckly S,Picard G,Rogemond V,Magalhaes É,Sharshar T,Timsit JF,Honnorat J,Sonnevildoi
10.1164/rccm.201603-0507OCsubject
Has Abstractpub_date
2017-02-15 00:00:00pages
491-499issue
4eissn
1073-449Xissn
1535-4970journal_volume
195pub_type
杂志文章,多中心研究abstract::The purpose of this study was to evaluate the physiologic responses to endurance training in patients with moderate to severe airflow obstruction by specifically looking at changes in skeletal muscle enzymatic activities. Eleven patients (age = 65 +/- 7 yr, mean +/- SD, FEV1 = 36 +/- 11% of predicted value, range = 24...
journal_title:American journal of respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1164/ajrccm.154.2.8756820
更新日期:1996-08-01 00:00:00
abstract::Several studies have found that sleep deprivation reduces the hypercapnic ventilatory response (HCVR). Such results may have been affected by uncontrolled activities or environmental influences during the sleep deprivation period. The current study determined the "pure" effect of sleep deprivation on respiratory contr...
journal_title:American journal of respiratory and critical care medicine
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journal_title:American journal of respiratory and critical care medicine
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doi:10.1164/rccm.201110-1849OC
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doi:10.1164/rccm.201209-1665OC
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journal_title:American journal of respiratory and critical care medicine
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doi:10.1164/rccm.200810-1596OC
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abstract::We found that continuous eosinophilic inflammation after repeated antigen instillation into the nose was observed only in A/J mice, not in three other strains. Histologic analysis of tissues from A/J mice revealed features typical of airway remodeling, i.e., airway wall thickening and increased collagen depositions we...
journal_title:American journal of respiratory and critical care medicine
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doi:10.1164/rccm.200210-1188OC
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abstract:RATIONALE:Secondhand tobacco smoke (SHS) and traffic-related air pollutants are associated with asthma and allergy. Diesel exhaust particles (DEPs) and SHS can interact with allergens in exacerbating allergic airway diseases through generation of reactive oxygen species. Glutathione S-transferases (GSTs) metabolize rea...
journal_title:American journal of respiratory and critical care medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2006-12-15 00:00:00
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journal_title:American journal of respiratory and critical care medicine
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journal_title:American journal of respiratory and critical care medicine
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pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:American journal of respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1164/ajrccm.154.1.8680680
更新日期:1996-07-01 00:00:00
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journal_title:American journal of respiratory and critical care medicine
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journal_title:American journal of respiratory and critical care medicine
pub_type: 临床试验,杂志文章
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更新日期:2009-07-15 00:00:00
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journal_title:American journal of respiratory and critical care medicine
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更新日期:2006-01-01 00:00:00
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journal_title:American journal of respiratory and critical care medicine
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更新日期:2009-11-15 00:00:00
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更新日期:1999-05-01 00:00:00
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journal_title:American journal of respiratory and critical care medicine
pub_type: 杂志文章
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更新日期:1996-03-01 00:00:00
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journal_title:American journal of respiratory and critical care medicine
pub_type: 杂志文章
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更新日期:1997-02-01 00:00:00
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journal_title:American journal of respiratory and critical care medicine
pub_type: 临床试验,杂志文章
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更新日期:1994-11-01 00:00:00
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journal_title:American journal of respiratory and critical care medicine
pub_type: 临床试验,杂志文章
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更新日期:1999-02-01 00:00:00
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更新日期:2017-03-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2014-10-01 00:00:00