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

Chi, Xiaosa; Wang, W.; Huang, Caili; Wu, Mark; Zhang, L.; Li, J.; Zhou, Dong

doi:10.1111/ane.12723

Cited by 81 publications

(90 citation statements)

References 24 publications

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“…In addition, a more aggressive treatment approach and prevention of detrimental courses by proactive ICU admission in more recent years might have played a role. Moreover, we could not confirm the observations from mostly larger but historical patient series which disclosed an association of age, ICU admission, and poor functional outcome ( 4 , 8 , 13 , 26 ). Thus, whether increased earlier diagnosis, improved understanding, and an altered treatment approach are responsible for our observation, needs to be confirmed in future independent studies.…”

Section: Discussioncontrasting

confidence: 83%

“…Timely diagnosis and initiation of immunotherapy is a key prognostic factor ( 8 , 11 ). Development of life-threatening complications requiring ICU admission has been linked to a prolonged hospital stay and lower likelihood of favorable outcome from AE ( 12 , 13 ). Unraveling risk factors for the development of critical illness in patients with AE could help to improve morbidity and mortality of this condition by allowing for early monitoring and aggressive supportive care.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

et al. 2017

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BackgroundPrevention and early recognition of critical illness in patients with autoimmune encephalitis (AE) is essential to achieve better outcome.Aim of the studyTo evaluate risk factors for intensive care unit (ICU) admission and its prognostic impact in patients with AE.Patients and methodsA 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%).ResultsICU 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.ConclusionWe 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.

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Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

et al. 2017

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“…Our sample showed that the non‐catatonic group had a higher mortality, mainly related to treatment‐resistant status epilepticus. In other studies, risk factors such as status epilepticus, admission to an intensive care unit, Glasgow Coma Scale score ≤ 8, and delay of immunomodulatory treatment have been associated to a poorer prognosis in terms of morbidity and mortality …”

Section: Discussionmentioning

confidence: 95%

“…In other studies, risk factors such as status epilepticus, admission to an intensive care unit, Glasgow Coma Scale score ≤ 8, and delay of immunomodulatory treatment have been associated to a poorer prognosis in terms of morbidity and mortality. 1,22 In our sample, symptomatic treatment of severe catatonic excitement was required for the safe use of plasma exchange. Rather than attempting to treat catatonia itself expecting its remission, the goal of these symptomatic treatments was to keep patients as safe as possible (using the safest psychotropics as needed, including lorazepam) while the underlying condition was treated with immunotherapy.…”

Section: Discussionmentioning

confidence: 98%

Catatonia in patients with anti‐NMDA receptor encephalitis

Espínola-Nadurille

Flores‐Rivera

Rivas‐Alonso

et al. 2019

Psychiatry Clin Neurosci

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Aim There is a lack of studies related to the frequency, phenomenology, and associated features of catatonic syndrome in patients with anti‐NMDA receptor encephalitis (ANMDARE). This study aimed to measure the frequency of catatonia in this condition and to delineate its particular symptoms. Methods A prospective study was done with all inpatients who fulfilled the criteria of definite ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico from January 2014 to September 2018. The Bush–Francis Catatonia Rating Scale and Braünig Catatonia Rating Scale were administered at admission. Results Fifty‐eight patients were included and catatonia was diagnosed in 41 of these patients (70.6%). Immobility, staring, mutism, and posturing were the most frequent catatonic signs. Catatonia was associated with delirium, hallucinations, psychomotor agitation, generalized electroencephalography dysfunction, and previous use of antipsychotics. Mortality was present in 10% of the total sample; it was associated with status epilepticus, and was less frequent in the catatonia group. After immunotherapy, all cases showed a complete recovery from catatonic signs. Conclusion This systematic assessment of catatonic syndrome shows that it is a frequent feature in patients with ANMDARE as part of a clinical pattern that includes delirium, psychomotor agitation, and hallucinations. The lack of recognition of this pattern may be a source of diagnostic and therapeutic errors, as most physicians associate catatonia with schizophrenia and affective disorders.

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“…The relapse rate may be associated with duration of followup. The fatality rate of anti-NMDAR encephalitis ranges from 0-12.5% [10,28,29,20,16,14,15] (See Additional le 1: Table S1). While it was 1.8% in current study, that was similar to studies from other region of China [20,16,14,15], which ranged from 0.0-2.3% (See Additional le 1: Table S1), being relatively low.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Anti-NMDAR Encephalitis in Southern China: Analysis of 107 Cases

Hou

et al. 2020

Preprint

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Background: Research on pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is limited. We studied clinical features of children with anti-NMDAR encephalitis in southern China.Methods: Pediatric anti-NMDAR encephalitis between 2014 and 2019 from one tertiary medical center was analyzed. The Modified Rankin Scale (mRS) score was adopted to evaluate outcomes.Results: 107 children (M/F=50/57; mean onset age=6.3 y) with anti-NMDAR encephalitis were involved. Boys significantly showed earlier onset age, higher ratio of fever, longer hospital day, more courses of steroid treatment, higher mRS score after treatment. 48.6% of patients had prodromal events with infectious events most common. The most common symptom at onset and during whole course was seizures and psychiatric symptoms respectively. Initial median white cell count of cerebral spinal fluid (CSF) was 22.0x106/L. 12.1% of patients had positive herpes simplex virus DNA of CSF. All patients had CSF positive NMDAR antibodies, although 86.9% of patients had serologically positive. 9.3% of patients had overlapped other neuronal antibodies. Electroencephalograph showed abnormalities with slow wave (95.3%) and epileptic activity (41.5%). Delta brush was revealed in 3.8% of patients. 36.4% of patients had lesions in brain MRI, with local lesions most common. No tumor was found in all. 84.9% of patients responded well to the first line therapy (steroid plus immunoglobulin), while 12 patients accepted second-line therapy (Rituximab) with 91.7% of effective rate. 12.1% of patients relapsed. 2 male patients died. The median length of hospital stay was 28 days. The mRS score was significantly improved after treatment. 51.0% of patients had a full recovery. 76.6% of patients had mild neurological disability (mRS≤2). Male, speech disorder, initial score of mRS and administration of second-line therapy were independent risk factors associated with the outcome.Conclusions: Of pediatric anti-NMDAR encephalitis in southern China: the mean onset age was about 6-year-old, earlier in boys; boys remained slower to recover and with a worse prognosis; the most common respective symptom at onset and during whole course was seizures and psychiatric symptoms; combination with tumor was rare; most patients respond well to the immunotherapy; relapse and fatality rate were relatively low; most patients had a good prognosis.

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

Abstract: 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.

Cited by 81 publications

References 24 publications

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

Catatonia in patients with anti‐NMDA receptor encephalitis

Pediatric Anti-NMDAR Encephalitis in Southern China: Analysis of 107 Cases

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