Hans-Berger-Department of Neurology (J.S., D.B., C.G., O.W.W., A.G.), Jena University Hospital; Department of Neurology (H.B.H., S.T.G.), University Hospital Erlangen; Department of Neurology and Neurophysiology (H.F), University Hospital Freiburg; Department of Neurology (N.M., A.D.), University Hospital Münster; Department of Neurology (H.P., L.-T.L), Charité University Medicine Berlin; Department of Neurology (K.F.), Bezirksklinikum Regensburg; Neuroimmunology Section (F.L., G.N.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein, Kiel; Department of Neurology (I.S.), University Hospital Giessen; Center for Neurology and Psychiatrics (C.D.), University Hospital Köln; Department of Neurology (J.B.), University Hospital Heidelberg; Department of Neurology (J.B.), Klinikum Kassel; Department of Neurology (J.L.), University Hospital Ulm; Institute of Clinical Neuroimmunology (F.T.), Ludwig-Maximillians-University München; Department of Neurology (A.K.), Martha Maria Hospital Halle; Department of Neurology (A.J.), Dortmund Hospital; Department of Neurology (M.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (K.-W.S.), University Hospital Hannover; Department of Neurology (C.U.), Hospital Ludwigshafen; Institute of Medical Statistics, Computer and Data Sciences (A.S), Jena University Hospital; and Center for Sepsis Control and Care (A.S., C.G.), Jena University Hospital, Germany.
Neurol Neuroimmunol Neuroinflamm. 2018 Oct 30;6(1):e514. doi: 10.1212/NXI.0000000000000514. eCollection 2019 Jan.
To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE).
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.
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.
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.
评估重症监护病房（ICU）并发症、管理及其与预后相关的因素，以此分析自身免疫性脑炎（AE）患者队列的结局。
本研究是一项观察性、多中心登记研究，连续纳入了 2004 年至 2016 年期间，18 家三级医院收治的需要神经重症监护治疗的自身免疫性脑炎患者。使用逻辑回归模型探讨并发症、管理及其诊断发现对出院时（0-3 分与 4-6 分）改良 Rankin 量表评分的影响。
120 例 AE 患者（中位年龄 43 岁[四分位间距 24-62]；70 例女性）中，101 例出现意识障碍，54 例出现自主神经功能障碍，42 例癫痫发作，39 例严重脓毒症。68 例患者需要机械通气，85 例患者可检测到神经元自身抗体，35 例患者为血清阴性。出院时神经功能结局较差与机械通气（校正后 OR 6.28；95%CI，2.71-15.61）、气管切开（校正后 OR 6.26；95%CI，2.68-15.73）、肿瘤（校正后 OR 3.73；95%CI，1.35-11.57）、脓毒症（校正后 OR 4.54；95%CI，1.99-10.43）或自主神经功能障碍（校正后 OR 2.91；95%CI，1.24-7.3）有关。未观察到自身抗体类型、CSF 炎症改变或病理性 MRI 与结局之间存在显著相关性。
在 AE 患者中，机械通气、脓毒症和自主神经功能障碍似乎表明康复时间更长或不完整。经典 ICU 并发症比 AE 的特定亚型更能作为预后标志物。需要提高对这些 AE 相关并发症的认识并进行有效管理，还需要进一步的前瞻性研究来证实我们的发现，并制定改善结局的具体策略。
