Citation

Schubert J, Brämer D, Huttner HB, Gerner ST, Fuhrer H, Melzer N, Dik A, Prüss H, Ly LT, Fuchs K, Leypoldt F, Nissen G, Schirotzek I, Dohmen C, Bösel J, Lewerenz J, Thaler F, Kraft A, Juranek A, Ringelstein M, Sühs KW, Urbanek C, Scherag A, Geis C, Witte OW, Günther A. Neurology: Neuroimmunology and NeuroInflammation 2019; 6(1).

Copyright

(Copyright © 2019)

DOI

10.1212/NXI.0000000000000514

PMID

unavailable

Abstract

OBJECTIVE To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE).

METHODS 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.

RESULTS 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.

CONCLUSION 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. © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Language: en

Keywords

adolescent; adult; human; child; female; male; prognosis; aged; resuscitation; suicide attempt; disease severity; medical ethics; rhabdomyolysis; major clinical study; mental disease; anticonvulsive agent; hospital admission; length of stay; cognitive defect; sedation; tachycardia; unclassified drug; automutilation; priority journal; headache; somnolence; opiate; coma; myoclonus; nuclear magnetic resonance imaging; gastrointestinal symptom; lung embolism; electrolyte disturbance; sepsis; benzodiazepine derivative; hospital discharge; diarrhea; hypersalivation; multicenter study; delirium; fever; artificial ventilation; cohort analysis; atypical antipsychotic agent; allergic reaction; heart arrhythmia; anemia; electroencephalogram; autonomic dysfunction; levodopa; cerebellum disease; respiratory failure; 4 aminobutyric acid; encephalitis; epileptic state; propofol; hyperventilation; bradycardia; pneumonia; brain stem; pneumothorax; adult respiratory distress syndrome; ileus; postoperative complication; motor dysfunction; Article; dantrolene; observational study; consciousness disorder; tracheostomy; septic shock; vein thrombosis; weakness; mutism; catheter infection; ventilator associated pneumonia; pleura effusion; isoflurane; protein cerebrospinal fluid level; Rankin scale; oligoclonal band; autoantibody; clinical outcome; prodromal symptom; paraneoplastic neuropathy; epileptic discharge; encephalomyelitis; hypoventilation; do not resuscitate order; allergic encephalitis; brain protein; cerebellitis; contactin associated protein 2; do not intubate order; glutamate decarboxylase; leucine rich glioma inactivated 1; neurological intensive care unit; pleocytosis; Rasmussen syndrome; sopor; voltage gated potassium channel