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

Abstract

To identify the risk factors of pneumonia in patients with Anti-N-methyl-D-aspartate (Anti-NMDA) receptor encephalitis. This is a retrospective study. Department of Neurology in West China Hospital of Sichuan University. Patients with a definitive diagnosis of anti-NMDA receptor encephalitis. Risk factors associated with pneumonia were examined by bivariate analysis and multivariate logistic regression model. A total of 104 patients were included in this study, of which 41% patients (n = 43) were diagnosed with pneumonia at 7 days (range: 4–40 days) after admission. The occurrence of pneumonia was associated with prolonged hospital stays, a higher rate of poor outcome, and extra healthcare costs. Risk factors associated with pneumonia included Glasgow coma scale score (GCS), abnormal movements and hypokalemia. Pneumonia is a common complication in anti-NMDA receptor encephalitis. In the present study, we found that disorders of consciousness, abnormal movements, and hypokalemia were independent risk factors for pneumonia in inpatients with anti-NMDA receptor encephalitis. Pneumonia prolongs the patients’ hospital stay, hospitalization expenditures, and affects the patients’ prognosis.

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis

“…NMDAR antibodiesmediated GABA dysfunction can cause frontostriatal syndrome and brainstem disinhibition (17), resulting in patients with MDs, autonomic dysfunction, and various sleep problems before onset, throughout the disease, and even after recovery (23). Therefore, (24) study found that abnormal movements were an independent risk factor for the development of pneumonia (odds ratio = 3.716, 95% confidence interval = 1.149-12.015, p = 0.028). We consider the following reasons for the above finding may be as follows: firstly, OFLD involving the mouth, tongue, and face is the most common MD, which can affect the oral phase of the normal swallowing process (25), and may lead to dysphagia and aspiration.…”

Ovarian teratoma-associated anti-NMDA receptor encephalitis with severe features

“…Severe movement disorders and autonomic instability often necessitate a prolonged intensive care unit stay. Hospital-associated complications are common, including ventilator-associated pneumonia in approximately 50% of all admissions, urinary tract infections and catheter-related bloodstream infections 16 17. Despite the severity of most presentations, up to 70% of patients will recover, although with the possibility of disease relapse in approximately 15% of survivors 9 18.…”