Zhao WenYan, Zhou YuLiang, Hu YingYing, Luo WenJing, Wang Jing, Zhu Hong, Xu ZhiPeng
Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
Department of Neurology, General Hospital of Central Theater Command, Wuhan, People's Republic of China.
BMC Infect Dis. 2024 Apr 22;24(1):421. doi: 10.1186/s12879-024-09312-1.
There are few thorough studies assessing predictors of severe encephalitis, despite the poor prognosis and high mortality associated with severe encephalitis. The study aims to evaluate the clinical predictors of mortality and poor outcomes at hospital discharge in patients with severe infectious encephalitis in intensive care units.
In two Chinese hospitals, a retrospective cohort study comprising 209 patients in intensive care units suffering from severe infectious encephalitis was carried out. Univariate and multivariate logistic regression analyses were used to identify the factors predicting mortality in all patients and poor outcomes in all survivors with severe infectious encephalitis.
In our cohort of 209 patients with severe encephalitis, 22 patients died, yielding a mortality rate of 10.5%. Cerebrospinal fluid pressure ≥ 400mmHO (OR = 7.43), abnormal imaging (OR = 3.51), abnormal electroencephalogram (OR = 7.14), and number of rescues (OR = 1.12) were significantly associated with an increased risk of mortality in severe infectious encephalitis patients. Among the 187 survivors, 122 (65.2%) had favorable outcomes, defined as the modified Rankine Scale (mRS) score (0 ~ 3), and 65(34.8%) had poor outcomes (mRS scores 4 ~ 5). Age (OR = 1.02), number of rescues (OR = 1.43), and tubercular infection (OR = 10.77) were independent factors associated with poor outcomes at discharge in all survivors with severe infectious encephalitis.
Multiple clinical, radiologic, and electrophysiological variables are independent predictive indicators for mortality and poor outcomes in patients with severe encephalitis in intensive care units. Identifying these outcome predictors early in patients with severe encephalitis may enable the implementation of appropriate medical treatment and help reduce mortality rates.
尽管重症脑炎预后差、死亡率高，但很少有全面评估重症脑炎预测因素的研究。本研究旨在评估重症监护病房中重症感染性脑炎患者出院时死亡率和不良预后的临床预测因素。
在中国的两家医院开展了一项回顾性队列研究，纳入了209例重症监护病房中患有重症感染性脑炎的患者。采用单因素和多因素逻辑回归分析来确定预测所有患者死亡率以及所有重症感染性脑炎幸存者不良预后的因素。
在我们的209例重症脑炎患者队列中，22例死亡，死亡率为10.5%。脑脊液压力≥400mmH₂O（比值比[OR]=7.43）、影像学异常（OR=3.51）、脑电图异常（OR=7.14）以及抢救次数（OR=1.12）与重症感染性脑炎患者死亡风险增加显著相关。在187名幸存者中，122例（65.2%）预后良好，定义为改良Rankin量表（mRS）评分（0～3），65例（34.8%）预后不良（mRS评分4～5）。年龄（OR=1.02）、抢救次数（OR=1.43）和结核感染（OR=10.77）是所有重症感染性脑炎幸存者出院时预后不良的独立相关因素。
多种临床、放射学和电生理变量是重症监护病房中重症脑炎患者死亡率和不良预后的独立预测指标。在重症脑炎患者中早期识别这些预后预测因素可能有助于实施适当的治疗并降低死亡率。
