Roberts Jackson A, Ridha Mohamed, Kim Carla Y, Sun Yifei, Carroll Elizabeth, Claassen Jan, Thakur Kiran T
Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Department of Neurology, Massachusetts General Brigham, Boston, MA, USA.
Neurocrit Care. 2025 May 29. doi: 10.1007/s12028-025-02287-0.
Prognosis of acute encephalitis is variable and dependent on the underlying etiology, early treatment, and clinical course. Despite extensive evaluation, a cause of acute encephalitis may not be discovered, presenting a challenge to clinicians when discussing prognosis with families. We sought to determine whether clinical and radiographic features may discriminate short-term outcomes in patients with severe cryptogenic encephalitis.
We performed a single-center, retrospective study of patients admitted with cryptogenic encephalitis (i.e., unknown etiology at time of discharge) to the Columbia University Irving Medical Center neurologic intensive care unit (ICU) and the Morgan Stanley Children's Hospital ICU from 2010 to 2020. A favorable discharge outcome was defined as Glasgow Outcome Scale score greater than or equal to 4. Using multivariable logistic regression modeling, we analyzed clinical and radiographic variables associated with favorable short-term outcome.
Among 204 total patients with encephalitis admitted to the ICU, 51.0% were classified as cryptogenic. The median age was 49.9 (interquartile range 31-64) years, and the most common presenting symptoms were altered mental status (74.0%), fever (56.7%), and headache (46.2%). Favorable outcome occurred in 63.5% of cryptogenic cases. In the fully adjusted model, age above 50 years (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.11-0.81; p = 0.017), active malignancy (OR 0.07, 95% CI 0.01-0.63; p = 0.018), and intubation (OR 0.20, 95% CI 0.07-0.55, p = 0.002) were associated with reduced odds of favorable outcome. Older age, active malignancy, and intubation were identified as predictors of lower Glasgow Outcome Scale score using ordinal logistic regression.
Clinical characteristics may aid early prognostication of cryptogenic encephalitis. Further mechanistic study of the association between active malignancy among patients with cryptogenic encephalitis is warranted.
急性脑炎的预后各不相同，取决于潜在病因、早期治疗及临床病程。尽管进行了广泛评估，急性脑炎的病因仍可能无法查明，这给临床医生与患者家属讨论预后带来了挑战。我们试图确定临床和影像学特征是否能够区分重症隐源性脑炎患者的短期预后。
我们对2010年至2020年期间入住哥伦比亚大学欧文医学中心神经重症监护病房（ICU）以及摩根士丹利儿童医院ICU的隐源性脑炎患者（即出院时病因不明）进行了一项单中心回顾性研究。良好的出院结局定义为格拉斯哥预后量表评分大于或等于4分。我们使用多变量逻辑回归模型分析了与良好短期结局相关的临床和影像学变量。
在入住ICU的204例脑炎患者中，51.0%被归类为隐源性。中位年龄为49.9岁（四分位间距31 - 64岁），最常见的首发症状为精神状态改变（74.0%）、发热（56.7%）和头痛（46.2%）。63.5%的隐源性病例预后良好。在完全调整模型中，年龄大于50岁（比值比[OR] 0.30，95%置信区间[CI] 0.11 - 0.81；p = 0.017）、活动性恶性肿瘤（OR 0.07，95% CI 0.01 - 0.63；p = 0.018）以及插管（OR 0.20，95% CI 0.07 - 0.55，p = 0.002）与良好结局的几率降低相关。使用有序逻辑回归分析，年龄较大、活动性恶性肿瘤和插管被确定为格拉斯哥预后量表评分较低的预测因素。
临床特征可能有助于隐源性脑炎的早期预后评估。有必要对隐源性脑炎患者中活动性恶性肿瘤之间的关联进行进一步机制研究。
