Harutyunyan Gayane, Hauer Larissa, Dünser Martin W, Karamyan Anush, Moser Tobias, Pikija Slaven, Leitinger Markus, Novak Helmut F, Trinka Eugen, Sellner Johann
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
Department of Psychiatry, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
Neurocrit Care. 2017 Aug;27(1):82-89. doi: 10.1007/s12028-016-0370-7.
Early recognition and treatment of autoimmune encephalitis (AE) has become an essential issue in clinical practice. However, little is known about patients with deteriorating conditions and the need for intensive care treatment. Here, we aimed to characterize underlying aetiologies, clinical symptoms, reasons for intensive care admission, and mortality of critically ill patients with AE.
We conducted a retrospective chart review of all patients with "definite" or "probable" diagnoses of AE treated at our neurological intensive care unit between 2002 and 2015. We collected and analyzed clinical, paraclinical, laboratory findings and assessed the mortality at last follow-up based on patient records.
Twenty-seven patients [median age 55 years (range 25-87), male = 16] were included. Thirteen (48%) had "definite" AE. The most common reasons for admission were status epilepticus (7/27, 26%) and delirium (4/27, 15%). One-year survival was 82%, all five deceased were male, and 3 (60%) of them had "probable" disease. The non-survivors (median follow-up 1 year) were more likely to have underlying cancer and higher need for respiratory support compared to the survivors (p < 0.041, and p = 0.004, respectively).
Clinical presentations and outcomes in critically ill patients with AE are diverse, and the most common leading cause for intensive care unit admission was status epilepticus. The association of comorbid malignancy and the need for mechanical ventilation with mortality deserves further attention.
自身免疫性脑炎（AE）的早期识别与治疗已成为临床实践中的重要问题。然而，对于病情恶化的患者以及重症监护治疗的需求了解甚少。在此，我们旨在明确重症AE患者的潜在病因、临床症状、重症监护入院原因及死亡率。
我们对2002年至2015年间在我院神经重症监护病房接受治疗的所有“确诊”或“疑似”AE患者进行了回顾性病历审查。我们收集并分析了临床、辅助检查、实验室检查结果，并根据患者记录评估了末次随访时的死亡率。
纳入27例患者[中位年龄55岁（范围25 - 87岁），男性16例]。13例（48%）为“确诊”AE。最常见的入院原因是癫痫持续状态（7/27，26%）和谵妄（4/27，15%）。1年生存率为82%，所有5例死亡患者均为男性，其中3例（60%）为“疑似”病例。与幸存者相比，非幸存者（中位随访1年）更易患有潜在癌症且对呼吸支持的需求更高（分别为p < 0.041和p = 0.004）。
重症AE患者的临床表现和预后各不相同，重症监护病房入院最常见的主要原因是癫痫持续状态。合并恶性肿瘤以及机械通气需求与死亡率之间的关联值得进一步关注。
