Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment

Schubert J, Braemer D, Huttner H, Gerner S, Fuhrer H, Melzer N, Dik A, Pruess H, Ly LT, Fuchs K, Leypoldt F, Nissen G, Schirotzek I, Dohmen C, Boesel J, Lewerenz J, Thaler F, Kraft A, Juranek A, Ringelstein M, Suehs KW, Urbanek C, Scherag A, Geis C, Witte OW, Guenther A (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 6

Pages Range: e514

Journal Issue: 1

DOI: 10.1212/NXI.0000000000000514

Abstract

To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE).This study was an observational multicenter registry of consecutively included patients diagnosed with AE requiring Neuro-ICU treatment between 2004 and 2016 from 18 tertiary hospitals. Logistic regression models explored the influence of complications, their management, and diagnostic findings on the dichotomized (0-3 vs 4-6) modified Rankin Scale score at hospital discharge.Of 120 patients with AE (median age 43 years [interquartile range 24-62]; 70 females), 101 developed disorders of consciousness, 54 autonomic disturbances, 42 status epilepticus, and 39 severe sepsis. Sixty-eight patients were mechanically ventilated, 85 patients had detectable neuronal autoantibodies, and 35 patients were seronegative. Worse neurologic outcome at hospital discharge was associated with necessity of mechanical ventilation (sex- and age-adjusted OR 6.28; 95% CI, 2.71-15.61) tracheostomy (adjusted OR 6.26; 95% CI, 2.68-15.73), tumor (adjusted OR 3.73; 95% CI, 1.35-11.57), sepsis (adjusted OR 4.54; 95% CI, 1.99-10.43), or autonomic dysfunction (adjusted OR 2.91; 95% CI, 1.24-7.3). No significant association was observed with autoantibody type, inflammatory changes in CSF, or pathologic MRI.In patients with AE, mechanical ventilation, sepsis, and autonomic dysregulation appear to indicate longer or incomplete convalescence. Classic ICU complications better serve as prognostic markers than the individual subtype of AE. Increased awareness and effective management of these AE-related complications are warranted, and further prospective studies are needed to confirm our findings and to develop specific strategies for outcome improvement.

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Additional Organisation(s)

Involved external institutions

Universitätsklinikum Ulm Germany (DE) Universitätsklinikum Münster Germany (DE) Universitätsklinikum Jena Germany (DE) Universitätsklinikum Freiburg Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Medizinische Einrichtungen des Bezirks Oberpfalz (medbo) Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Heinrich-Heine-Universität Düsseldorf Germany (DE) Krankenhaus Martha-Maria Halle-Dölau Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Klinikum Dortmund Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsklinikum Köln Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE) Universitätsklinikum Heidelberg Germany (DE)

How to cite

APA:

Schubert, J., Braemer, D., Huttner, H., Gerner, S., Fuhrer, H., Melzer, N.,... Guenther, A. (2019). Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment. Neurology, Neuroimmunology and Neuroinflammation, 6(1), e514. https://dx.doi.org/10.1212/NXI.0000000000000514

MLA:

Schubert, Julia, et al. "Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment." Neurology, Neuroimmunology and Neuroinflammation 6.1 (2019): e514.

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