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脑炎:临床及诊断数据对预后的预测作用——一项单中心研究

Encephalitis: Predictive Role of Clinical and Diagnostic Data on Outcome-A Monocentric Study.

作者信息

Erhart Deborah K, Balz Luisa T, Tumani Hayrettin

机构信息

Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.

出版信息

Life (Basel). 2025 Aug 19;15(8):1313. doi: 10.3390/life15081313.

DOI:10.3390/life15081313
PMID:40868960
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12387950/
Abstract

Encephalitis is a potentially life-threatening condition with long-term neurological sequelae. However, data on early clinical, demographic, and diagnostic predictors of functional outcomes remain limited. We performed a retrospective monocentric study including 98 patients diagnosed with infectious encephalitis of various etiologies treated in the University Hospital Ulm between January 2014 and December 2024. Ordinal logistic regression models were applied to evaluate associations between admission characteristics and functional outcome at discharge, as measured by the modified Rankin Scale. Three multivariate models incorporating clinical, demographic, and MRI/EEG variables explained up to 53% of the variance in mRS at discharge ( < 0.001), outperforming models based solely on CSF parameters. Key predictors of poor functional outcome included 'altered consciousness' (OR 7.08, < 0.001), higher 'mRS at admission' (OR 0.03-0.07 across categories, < 0.001), 'focal/generalized EEG slowing' (OR 9.97, < 0.001), 'epileptiform EEG activity' (OR 17.49, < 0.001), 'MRI: myelitis' (OR 16.44, = 0.004), and 'intrathecal IgM synthesis' (OR 8.93, = 0.018). Conversely, 'longer hospitalization' (OR 0.13-0.17 for different intervals, < 0.006) and 'intrathecal IgG synthesis' (OR 0.05, = 0.03) were associated with more favorable outcomes. Despite the single-center and retrospective aspects of this study, our findings underscore a multifactorial pattern of outcome determinants in infectious encephalitis, highlighting the prognostic relevance of initial neurological status, electrophysiological abnormalities, and neuroimaging features.

摘要

脑炎是一种可能危及生命的疾病,可导致长期神经后遗症。然而,关于功能预后的早期临床、人口统计学和诊断预测因素的数据仍然有限。我们进行了一项回顾性单中心研究,纳入了2014年1月至2024年12月期间在乌尔姆大学医院接受治疗的98例诊断为各种病因感染性脑炎的患者。采用有序逻辑回归模型评估入院特征与出院时功能预后之间的关联,功能预后通过改良Rankin量表进行测量。三个纳入临床、人口统计学和MRI/EEG变量的多变量模型解释了出院时mRS方差的53%(<0.001),优于仅基于脑脊液参数的模型。功能预后不良的关键预测因素包括“意识改变”(OR 7.08,<0.001)、入院时较高的“mRS”(各分类的OR为0.03 - 0.07,<0.001)、“局灶性/全身性EEG减慢”(OR 9.97,<0.001)、“癫痫样EEG活动”(OR 17.49,<0.001)、“MRI:脊髓炎”(OR 16.44,=0.004)和“鞘内IgM合成”(OR 8.93,=0.018)。相反,“住院时间较长”(不同时间段的OR为0.13 - 0.17,<0.006)和“鞘内IgG合成”(OR 0.05,=0.03)与更有利的预后相关。尽管本研究具有单中心和回顾性的特点,但我们的发现强调了感染性脑炎预后决定因素的多因素模式,突出了初始神经状态、电生理异常和神经影像学特征的预后相关性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/e7a507a049ce/life-15-01313-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/9dae8c654aca/life-15-01313-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/8603ad88e782/life-15-01313-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/e7a507a049ce/life-15-01313-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/9dae8c654aca/life-15-01313-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/8603ad88e782/life-15-01313-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a9d/12387950/e7a507a049ce/life-15-01313-g003.jpg

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CXCL13 in Cerebrospinal Fluid: Clinical Value in a Large Cross-Sectional Study.
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