Hansen Michael A, Samannodi Mohammed S, Hasbun Rodrigo
Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA.
Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Open Forum Infect Dis. 2020 Oct 7;7(11):ofaa471. doi: 10.1093/ofid/ofaa471. eCollection 2020 Nov.
Identifying underlying commonalities among all-cause encephalitis cases can be extraordinarily useful in predicting meaningful risk factors associated with inpatient mortality.
A retrospective cohort of patients with encephalitis was derived from a clinical chart review of adult patients (age ≥18 years) across 16 different hospitals in Houston, Texas, between January 2005 and July 2015. Clinical features at admission were assessed for their correlation with inpatient mortality and used to derive a final risk score prediction tool.
The study included a total of 273 adult patients with all-cause encephalitis, 27 (9.9%) of whom died during hospitalization. A limited number of clinical features were substantially different between patients who survived and those who died (Charlson score, Glasgow coma scale [GCS], immunosuppression, fever on admission, multiple serologic studies, and abnormal imaging). A final multivariable logistic model was derived with the following risk factors, which were transformed into a scoring system: 1 point was assigned to the presence of a Charlson score >2, thrombocytopenia, or cerebral edema, and 2 points for a GCS value <8. Patients were then classified into different risk groups for inpatient mortality: 0 points (0%), 1 point (7%), 2 points (10.9%), 3 points (36.8%), and ≥4 points (81.8%).
The risk score developed from this study shows a high predictive value. This can be highly beneficial in alerting care providers to key clinical risk factors associated with in-hospital mortality in adults with encephalitis.
识别所有病因所致脑炎病例的潜在共性，对于预测与住院死亡率相关的有意义风险因素可能极为有用。
通过对2005年1月至2015年7月期间得克萨斯州休斯敦16家不同医院的成年患者（年龄≥18岁）的临床病历进行回顾，得出一个脑炎患者的回顾性队列。评估入院时的临床特征与住院死亡率的相关性，并用于得出最终的风险评分预测工具。
该研究共纳入273例成年全病因脑炎患者，其中27例（9.9%）在住院期间死亡。存活患者和死亡患者之间的有限数量临床特征存在显著差异（查尔森评分、格拉斯哥昏迷量表[GCS]、免疫抑制、入院时发热、多项血清学检查以及影像学异常）。得出了一个最终的多变量逻辑模型，其包含以下风险因素，并将这些因素转化为一个评分系统：查尔森评分>2、血小板减少或脑水肿存在时计1分，GCS值<8时计2分。然后将患者分为不同的住院死亡风险组：0分（0%）、1分（7%）、2分（10.9%）、3分（36.8%）和≥4分（81.8%）。
本研究得出的风险评分显示出较高的预测价值。这对于提醒医护人员注意成年脑炎患者住院死亡相关的关键临床风险因素可能非常有益。
