He Yu, Li Fangfang, Yang Ali, Yu Chen, Wang Yifan, Zhao Jing, Zang Weizhou
Department of Neurology, Henan University People's Hospital, Zhengzhou, China.
Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.
Front Immunol. 2024 Dec 2;15:1490804. doi: 10.3389/fimmu.2024.1490804. eCollection 2024.
The Clinical Assessment Scale for Autoimmune Encephalitis (CASE) is a novel tool tailored specifically for evaluating the severity of autoimmune encephalitis (AE). However, its application in severe AE patients is limited. This study aimed to evaluate the reliability and validity of the CASE and explore its clinical significance in a severe AE cohort.
The relevant clinical characteristics, laboratory data, and prognosis of patients diagnosed with severe AE between April 2017 and April 2023 were collected. The CASE and modified Rankin scale (mRS) were performed at admission, discharge, and 1-year follow-up, respectively. The reliability of CASE was validated by calculating the Cronbach's alpha value. The validity was evaluated by calculating the Spearman's rank correlation with the corresponding mRS. Univariate and multivariate logistic regression were utilized to identify risk factors for poor prognosis.
A total of 140 patients were recruited for the study. The CASE scale presented great internal consistency, with Cronbach's α value of 0.768 for the total score. The Spearman's rank correlation analysis revealed strong criterion validity between CASE and mRS, with coefficients of 0.68, 0.92, and 0.95 at admission, discharge, and 1-year follow-up, respectively (all < 0.001). ROC analysis identified CASE score at admission served as a promising predictive marker for clinical response to treatment, with an AUC of 0.67 (95% CI: 0.57-0.77, = 0.003). The optimal cut-off point was 22.5. At 1-year follow-up, 72/140 (51.4%) patients achieved good functional status (mRS, 0-2). Multivariate logistic regression confirmed that higher CASE scores on admission and older age at onset were associated with poor short-term as well as 1-year prognosis, respectively. In addition, no clinical response to treatment (OR = 40.499; 95% CI: 7.077-231.746, < 0.001) and longer duration of hospitalization (OR = 1.071; 95% CI: 1.017-1.128, = 0.010) were associated with poor function states at 1-year follow-up.
The CASE has proven suitable for evaluating disease severity and prognosis in severe AE patients. Besides, CASE score, age at disease onset, hospital stays, and response to immunotherapy are identified as independent risk factors for unsatisfactory prognosis in severe AE patients.
自身免疫性脑炎临床评估量表（CASE）是一种专门为评估自身免疫性脑炎（AE）严重程度量身定制的新型工具。然而，其在重症AE患者中的应用有限。本研究旨在评估CASE的可靠性和有效性，并探讨其在重症AE队列中的临床意义。
收集2017年4月至2023年4月期间诊断为重症AE患者的相关临床特征、实验室数据及预后情况。分别在入院时、出院时及1年随访时进行CASE和改良Rankin量表（mRS）评估。通过计算Cronbach's α值验证CASE的可靠性。通过计算与相应mRS的Spearman等级相关性评估有效性。采用单因素和多因素逻辑回归确定预后不良的危险因素。
共纳入140例患者进行研究。CASE量表具有良好的内部一致性，总分的Cronbach's α值为0.768。Spearman等级相关性分析显示CASE与mRS之间具有较强的效标效度，入院时、出院时及1年随访时的系数分别为0.68、0.92和0.95（均<0.001）。ROC分析确定入院时的CASE评分可作为治疗临床反应的有前景的预测标志物，AUC为0.67（95%CI：0.57 - 0.77，P = 0.003）。最佳截断点为22.5。在1年随访时，72/140（51.4%）例患者功能状态良好（mRS，0 - 2）。多因素逻辑回归证实，入院时较高的CASE评分和发病时年龄较大分别与短期及1年预后不良相关。此外，对治疗无临床反应（OR = 40.499；95%CI：7.077 - 231.746，P < 0.001）和住院时间较长（OR = 1.071；95%CI：1.017 - 1.128，P = 0.010）与1年随访时功能状态不良相关。
CASE已被证明适用于评估重症AE患者的疾病严重程度和预后。此外，CASE评分、发病年龄、住院时间及免疫治疗反应被确定为重症AE患者预后不理想的独立危险因素。
