Analysis of Clinical Characteristics and Poor Prognostic Predictors in Patients With an Initial Diagnosis of Autoimmune Encephalitis

Abstract

Purpose: We aimed to retrospectively analyze the clinical features, laboratory and imaging results, and predictors of poor prognosis for patients with an initial diagnosis of autoimmune encephalitis (AE) at the Affiliated Hospital of Zunyi Medical University. Methods: Fifty patients with an initial diagnosis of AE who were admitted to our hospital from May 2014 to May 2018 were enrolled retrospectively. Clinical characteristics and experimental test data, including the neutrophil-to-lymphocyte ratio (NLR), were collected from medical records within 24 h of admission. Independent prognostic factors were determined by multivariate logistic regression analysis. A good or poor prognosis for patients was defined based on the modified Rankin Scale (mRS). The correlation between the immunotherapy latency and prognostic mRS score was determined using the Spearman rank correlation test. Results: Univariate analysis indicated that increased NLR ( P = 0.001), decreased lymphocyte counts ( P = 0.001), low serum albumin ( P = 0.017), consciousness disorders ( P = 0.001), epileptic seizures ( P = 0.007), extrapyramidal symptoms ( P = 0.042), abnormal electroencephalogram (EEG) findings ( P = 0.001), abnormal brain magnetic resonance imaging (MRI) findings ( P = 0.003), and pulmonary infection complications ( P = 0.000) were associated with the poor prognosis of AE. Multivariate logistic regression analysis showed that NLR (odds ratio [OR] 2.169, 95% confidence interval [CI] 1.029–4.570; P < 0.05) was an independent risk factor for predicting the poor prognosis of AE. NLR > 4.45 was suggested as the cut-off threshold for predicting the adverse outcomes of AE. In addition, we revealed that there was a positive correlation between immunotherapy latency and mRS score (r s = 0.535, P < 0.05). Conclusions: NLR may have predictive value for the poor outcomes of AE. Early initiation of immunotherapy is associated with a good prognosis.

Peripheral Immune Cell Ratios and Clinical Outcomes in Seropositive Autoimmune Encephalitis: A Study by the Australian Autoimmune Encephalitis Consortium

“…The optimal cut-off to predict severe disability (mRS >2) was an NLR >4.82 (AUC 0.875). A subsequent study examined a group of 50 AE cases and their long-term functional outcomes ( 10 ). The investigators found that after a median of 11 months follow-up, the NLR on admission was associated with higher odds of mRS >1 (OR 2.17, 95% CI 1.03–4.57).…”

“…We recorded the total white blood cell count and immune cell subset counts from the first full blood analysis within 24 h of admission ( 10 ). We excluded any patient who had confounding illness that with potential impact on white blood cell counts such as systemic infection.…”

“…In MS, the NLR has been demonstrated to correlate with disease progression and worse disability outcomes ( 7 – 9 ). Recent studies in AE have found that a high NLR is significantly correlated with long-term functional disability as measured by the mRS and reduced response to first line immunotherapy ( 10 , 11 ). The monocyte-to-lymphocyte (MLR) has recently been associated with disability scores in MS ( 9 ).…”

A case report of complement C4B deficiency in a patient with steroid and IVIG-refractory anti-NMDA receptor encephalitis

“…This would be relevant because complement activation on autologous cells are tightly controlled and mostly stop after the deposition of C4b. We postulate that C4B deficiency in our patient might have led to the defective removal of immune complexes and possibly impairment of yet to be characterized neurogenic pathways, which has a substantial role in autoimmune encephalitis [9][10][11]. Complement deficiency is ameliorated by plasmapheresis, which normally correct the complement deficiency, but not by IVIG.…”

Electroencephalography During the Acute Phase Of Encephalitis: A Brief Review

“…Multiple autoimmune encephalitis, either seropositive or negative, show different types of unspecific EEG alterations such as: frontal intermittent rhythmic delta activity (FIRDA), periodic lateralized epileptiform discharge (PLED), periodic epileptiform discharges (PED), generalized rhythmic delta activity (GRDA), excess beta activity (EBA) and triphasic waves [14][15][16][17][18]. An example is showed in Figure 4.…”