Habis Ralph, Heck Ashley, Bean Paris, Probasco John, Geocadin Romergryko G, Hasbun Rodrigo, Venkatesan Arun
Department of Neurology, Johns Hopkins Encephalitis Center, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 6-160, Baltimore, MD, 21287, USA.
Department of Medicine, Section of Infectious Disease, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
Neurocrit Care. 2025 Feb;42(1):196-206. doi: 10.1007/s12028-024-02063-6. Epub 2024 Jul 31.
Timely intensive care unit (ICU) admission for patients with encephalitis is associated with better prognosis. Therefore, our aim was to create a risk score predicting ICU admission in adults with encephalitis, which could aid in optimal management and resource allocation.
We initially identified variables that would be most predictive of ICU admission among 372 patients with encephalitis from two hospital systems in Houston, Texas (cohort 1), who met the International Encephalitis Consortium (IEC) criteria from 2005 to 2023. Subsequently, we used a binary logistic regression model to create a risk score for ICU admission, which we then validated externally using a separate cohort of patients from two hospitals in Baltimore, Maryland (cohort 2), who met the IEC criteria from 2006 to 2022.
Of 634 patients with encephalitis, 255 (40%) were admitted to the ICU, including 45 of 113 (39.8%) patients with an autoimmune cause, 100 of 272 (36.7%) with an infectious cause, and 110 of 249 (44.1%) with an unknown cause (p = 0.225). After conducting a multivariate analysis in cohort 1, we found that the presence of focal neurological signs, new-onset seizure, a Full Outline of Unresponsiveness score ≤ 14, leukocytosis, and a history of chronic kidney disease at admission were associated with an increased risk of ICU admission. The resultant clinical score for predicting ICU admission had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% confidence interval [CI] 0.72-0.82, p < 0.001). Patients were classified into three risk categories for ICU admission: low risk (score 0, 12.5%), intermediate risk (scores 1-5, 49.5%), and high risk (scores 6-8, 87.5%). External validation in cohort 2 yielded an AUROC of 0.76 (95% CI 0.69-0.83, p < 0.001).
ICU admission is common in patients with encephalitis, regardless of etiology. Our risk score, encompassing neurologic and systemic factors, may aid physicians in decisions regarding intensity of care for adult patients with encephalitis upon hospital admission.
脑炎患者及时入住重症监护病房（ICU）与更好的预后相关。因此，我们的目标是创建一个预测成人脑炎患者入住ICU的风险评分，这有助于优化管理和资源分配。
我们最初在德克萨斯州休斯顿两个医院系统的372例脑炎患者（队列1）中确定最能预测入住ICU的变量，这些患者符合2005年至2023年国际脑炎联盟（IEC）标准。随后，我们使用二元逻辑回归模型创建入住ICU的风险评分，然后使用来自马里兰州巴尔的摩两个医院的另一组患者（队列2）进行外部验证，这些患者符合2006年至2022年IEC标准。
在634例脑炎患者中，255例（40%）入住ICU，包括113例自身免疫性病因患者中的45例（39.8%）、272例感染性病因患者中的100例（36.7%）和249例病因不明患者中的110例（44.1%）（p = 0.225）。在队列1中进行多因素分析后，我们发现存在局灶性神经体征、新发癫痫、无反应性全面量表评分≤14、白细胞增多以及入院时的慢性肾脏病病史与入住ICU的风险增加相关。预测入住ICU的最终临床评分在受试者工作特征曲线下面积（AUROC）为0.77（95%置信区间[CI] 0.72 - 0.82，p < 0.001）。患者被分为入住ICU的三个风险类别：低风险（评分0，12.5%）、中度风险（评分1 - 5，49.5%）和高风险（评分6 - 8，87.5%）。队列2中的外部验证得出AUROC为0.76（95% CI 0.69 - 0.83，p < 0.001）。
无论病因如何，脑炎患者入住ICU很常见。我们包含神经和全身因素的风险评分可能有助于医生在成人脑炎患者入院时做出关于护理强度的决策。
