Schubert, Julia, Braemer, Dirk, Huttner, Hagen B., Gerner, Stefan T., Fuhrer, Hannah, Melzer, Nico, Dik, Andre, Pruess, Harald, Ly, Lam-Than, Fuchs, Kornelius, Leypoldt, Frank, Nissen, Gunnar, Schirotzek, Ingo, Dohmen, Christian, Boesel, Julian, Lewerenz, Jan, Thaler, Franziska, Kraft, Andrea, Juranek, Aleksandra, Ringelstein, Marius, Suehs, Kurt-Wolfram, Urbanek, Christian, Scherag, Andre, Geis, Christian, Witte, Otto W. and Guenther, Albrecht (2019). Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment. Neurol.-Neuroimmunol. Neuroinflammation, 6 (1). PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 2332-7812

Full text not available from this repository.

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Schubert, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Braemer, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerner, Stefan T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fuhrer, HannahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Melzer, NicoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dik, AndreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pruess, HaraldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ly, Lam-ThanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fuchs, KorneliusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leypoldt, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nissen, GunnarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schirotzek, IngoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boesel, JulianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lewerenz, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thaler, FranziskaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kraft, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Juranek, AleksandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ringelstein, MariusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Suehs, Kurt-WolframUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Urbanek, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Scherag, AndreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Geis, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Witte, Otto W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-140796
DOI: 10.1212/NXI.0000000000000514
Journal or Publication Title: Neurol.-Neuroimmunol. Neuroinflammation
Volume: 6
Number: 1
Date: 2019
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 2332-7812
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
NMDA-RECEPTOR ENCEPHALITIS; ANTIBODIES; PREDICTORS; SPECTRUMMultiple languages
Clinical Neurology; NeurosciencesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/14079

Downloads

Downloads per month over past year

Altmetric

Export

Actions (login required)

View Item View Item