Assistance Publique Hôpitaux de Paris AP-HP, Hôpital Bichat - Claude-Bernard, Service de Réanimation Médicale et Infectieuse, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Eur J Neurol. 2015 Jan;22(1):6-16, e1. doi: 10.1111/ene.12541. Epub 2014 Sep 1.
Our aim was to characterize the clinical profile, temporal changes and outcomes of patients with severe encephalitis.
A retrospective cohort study was conducted on adult patients with encephalitis admitted to the medical intensive care unit (ICU) of a university hospital over a 20-year period. Patients' characteristics and outcomes were compared between two 10-year periods: (i) 1991-2001 and (ii) 2002-2012. Multivariate logistic regression was used to analyze factors associated with a poor outcome, as defined by a modified Rankin scale (mRS) score of 4-6 (severe disability or death) 90 days after admission.
A total of 279 patients were studied. Causes of encephalitis were infections (n = 149, 53%), immune-mediated causes (n = 41, 15%) and undetermined causes (n = 89, 32%). The distribution of causes differed significantly between the two periods, with an increase in the proportion of encephalitis recognized to be of immune-mediated causes. At day 90, 208 (75%) patients had an mRS = 0-3 and 71 (25%) had an mRS = 4-6. After adjustment for functional status before admission, the following parameters were independently associated with a poor outcome: coma [odds ratio (OR) 7.09, 95% confidence interval (95% CI) 3.06-17.03], aspiration pneumonia (OR 4.02, 95% CI 1.47-11.03), a lower body temperature (per 1 degree, OR 0.72, 95% CI 0.53-0.97), elevated cerebrospinal fluid protein levels (per 1 g/l, OR 1.55, 95% CI 1.17-2.11) and delayed ICU admission (per 1 day, OR 1.04, 95% CI 1.01-1.07).
Indicators of outcome in adult patients with severe encephalitis reflect both the severity of illness and systemic complications. Our data suggest that patients with acute encephalitis may benefit from early ICU admission.
我们旨在描述重症脑炎患者的临床特征、时间变化和结局。
对 20 年间入住一所大学医院内科重症监护病房（ICU）的成年脑炎患者进行了一项回顾性队列研究。将患者的特征和结局在两个 10 年期间进行了比较：（i）1991-2001 年和（ii）2002-2012 年。采用多变量逻辑回归分析了与 90 天改良 Rankin 量表（mRS）评分 4-6 分（重度残疾或死亡）相关的不良结局的相关因素。
共研究了 279 例患者。脑炎的病因是感染（n = 149，53%）、免疫介导性病因（n = 41，15%）和未明确病因（n = 89，32%）。两个时期的病因分布有显著差异，免疫介导性病因所致脑炎的比例增加。90 天时，208 例（75%）患者的 mRS = 0-3 分，71 例（25%）患者的 mRS = 4-6 分。在校正入院前的功能状态后，以下参数与不良结局独立相关：昏迷[比值比（OR）7.09，95%置信区间（95%CI）3.06-17.03]、吸入性肺炎（OR 4.02，95%CI 1.47-11.03）、较低的体温（每 1 度，OR 0.72，95%CI 0.53-0.97）、升高的脑脊液蛋白水平（每 1 克/升，OR 1.55，95%CI 1.17-2.11）和 ICU 入住延迟（每 1 天，OR 1.04，95%CI 1.01-1.07）。
成人重症脑炎患者的结局指标反映了疾病的严重程度和全身并发症。我们的数据表明，急性脑炎患者可能受益于早期 ICU 入住。
