Risk factors for mortality in patients with anti-NMDA receptor encephalitis.

Abstract:

OBJECTIVE:Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune disorder with a mortality of 5%-7%, but few studies have focused on the predictors of death in this disease. In this study, we aim to investigate predictors and causes of death in patients with anti-NMDAR encephalitis. METHODS:In this cohort study, patients with anti-NMDAR encephalitis were enrolled at the West China Hospital of Sichuan University between June 2011 and October 2015. The outcomes of patients were evaluated by long-term follow-up. Cox regression analysis was used to assess the association between potential predictors and death. RESULTS:Altogether 96 patients were included in this study, and 11 died after median 24.5 (7-57) months of follow-up. The mortality of anti-NMDAR encephalitis was 11.46%. Multivariate analysis results showed that Glasgow Coma Scale (GCS) score ≤8 at admission (HR=15.917, 95% CI=1.729-146.562; P=.015), the number of complications (HR=7.772, 95% CI=1.944-31.072; P=.004), and admission to an intensive care unit (HR=70.158, 95% CI=2.395-2055.459; P=.014) were significantly associated with increased risk of mortality. Twelve patients received second-line immunotherapy, and the cohort was relatively under-treated compared with other studies. The main causes of death were severe pneumonia, multiple organ dysfunction syndrome, and refractory status epilepticus. CONCLUSION:GCS score ≤8 at admission, number of complications, and admission to an intensive care unit are predictors of death. Management of complications may improve the prognosis of anti-NMDAR encephalitis.

journal_name

Acta Neurol Scand

authors

Chi X,Wang W,Huang C,Wu M,Zhang L,Li J,Zhou D

doi

10.1111/ane.12723

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

298-304

issue

4

eissn

0001-6314

issn

1600-0404

journal_volume

136

pub_type

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