Chi X, Wang W, Huang C, Wu M, Zhang L, Li J, Zhou D
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Acta Neurol Scand. 2017 Oct;136(4):298-304. doi: 10.1111/ane.12723. Epub 2016 Dec 27.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune disorder with a mortality of 5%-7%, but few studies have focused on the predictors of death in this disease. In this study, we aim to investigate predictors and causes of death in patients with anti-NMDAR encephalitis.
In this cohort study, patients with anti-NMDAR encephalitis were enrolled at the West China Hospital of Sichuan University between June 2011 and October 2015. The outcomes of patients were evaluated by long-term follow-up. Cox regression analysis was used to assess the association between potential predictors and death.
Altogether 96 patients were included in this study, and 11 died after median 24.5 (7-57) months of follow-up. The mortality of anti-NMDAR encephalitis was 11.46%. Multivariate analysis results showed that Glasgow Coma Scale (GCS) score ≤8 at admission (HR=15.917, 95% CI=1.729-146.562; P=.015), the number of complications (HR=7.772, 95% CI=1.944-31.072; P=.004), and admission to an intensive care unit (HR=70.158, 95% CI=2.395-2055.459; P=.014) were significantly associated with increased risk of mortality. Twelve patients received second-line immunotherapy, and the cohort was relatively under-treated compared with other studies. The main causes of death were severe pneumonia, multiple organ dysfunction syndrome, and refractory status epilepticus.
GCS score ≤8 at admission, number of complications, and admission to an intensive care unit are predictors of death. Management of complications may improve the prognosis of anti-NMDAR encephalitis.
抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种严重的自身免疫性疾病，死亡率为5%-7%，但很少有研究关注该疾病死亡的预测因素。在本研究中，我们旨在调查抗NMDAR脑炎患者死亡的预测因素及原因。
在这项队列研究中，2011年6月至2015年10月期间，四川大学华西医院纳入了抗NMDAR脑炎患者。通过长期随访评估患者的预后情况。采用Cox回归分析评估潜在预测因素与死亡之间的关联。
本研究共纳入96例患者，中位随访24.5（7-57）个月后，11例死亡。抗NMDAR脑炎的死亡率为11.46%。多因素分析结果显示，入院时格拉斯哥昏迷量表（GCS）评分≤8（HR=15.917，95%CI=1.729-146.562；P=0.015）、并发症数量（HR=7.772，95%CI=1.944-31.072；P=0.004）以及入住重症监护病房（HR=70.158，95%CI=2.395-2055.459；P=0.014）与死亡风险增加显著相关。12例患者接受了二线免疫治疗，与其他研究相比，该队列治疗相对不足。主要死亡原因是重症肺炎、多器官功能障碍综合征和难治性癫痫持续状态。
入院时GCS评分≤8、并发症数量以及入住重症监护病房是死亡的预测因素。并发症的管理可能改善抗NMDAR脑炎的预后。
