需要重症监护的自身免疫性脑炎成年患者的临床特征与转归：一项回顾性队列研究
Clinical Features and Outcomes in Adult Patients with Autoimmune Encephalitis Requiring Intensive Care: A Retrospective Cohort Study.
作者信息
Qin Lixia, Chen Kexin, Zhou Yiwen, Wang Wei, Lu Wei, Zhang Hainan
机构信息
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Clinical Medical Research Center for Stroke Prevention and Treatment of Hunan Province, Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
出版信息
Neurocrit Care. 2025 Sep 16. doi: 10.1007/s12028-025-02374-2.
BACKGROUND
This study aims to explore the predictors of poor outcomes by analyzing the clinical characteristics and prognosis of adult patients with severe forms of autoimmune encephalitis (AE) requiring intensive care unit (ICU) admission.
METHODS
A retrospective analysis was conducted on 134 adult patients diagnosed with definite or possible AE and admitted to the neurology ICU between January 2015 and December 2023. Neurological outcomes at 6 and 12 months were assessed using the modified Rankin scale (mRS). The study further analyzed the relationship between their clinical characteristics, auxiliary examinations, and prognosis.
RESULTS
A total of 134 adult patients with AE requiring ICU admission were included. The 6- and 12-month survival rates were 91.8% and 91.5%, respectively. At 6 months, 72.4% (97 of 134) of patients had favorable outcomes (mRS score ≤ 2), whereas 27.6% (37 of 134) had poor outcomes (mRS score ≥ 3). Compared with the favorable group, patients in the poor outcome group were older (42.92 vs. 30.71 years, p = 0.002), had a higher incidence of tumors (24.3% vs. 4.1%, p < 0.001), and were more likely to require mechanical ventilation (67.6% vs. 26.8%, p < 0.001). They also had lower Glasgow Coma Scale scores on ICU admission (p = 0.006), higher Acute Physiology and Chronic Health Evaluation II scores (p = 0.006), elevated cerebrospinal fluid glucose (p = 0.004) and protein levels (p = 0.029), higher autoantibody seronegativity (32.4% vs. 13.4%, p = 0.011), lower glucocorticoid use (p = 0.038), and longer ICU stays (p = 0.031). Multivariate logistic regression identified age (p = 0.001), presence of tumor (p = 0.03), mechanical ventilation (p = 0.025), antibody negativity (p = 0.042), and ICU length of stay (p = 0.000) as independent predictors of poor prognosis.
CONCLUSIONS
These factors may help identify high-risk patients with AE early, enabling timely and targeted interventions to improve outcomes.
背景
本研究旨在通过分析需要入住重症监护病房（ICU）的成年自身免疫性脑炎（AE）重症患者的临床特征和预后，探索预后不良的预测因素。
方法
对2015年1月至2023年12月期间确诊为明确或可能的AE并入住神经内科ICU的134例成年患者进行回顾性分析。使用改良Rankin量表（mRS）评估6个月和12个月时的神经功能结局。该研究进一步分析了他们的临床特征、辅助检查与预后之间的关系。
结果
共纳入134例需要入住ICU的成年AE患者。6个月和12个月的生存率分别为91.8%和91.5%。在6个月时，72.4%（134例中的97例）的患者预后良好（mRS评分≤2），而27.6%（134例中的37例）预后不良（mRS评分≥3）。与预后良好组相比，预后不良组患者年龄更大（42.92岁对30.71岁，p = 0.002），肿瘤发生率更高（24.3%对4.1%，p < 0.001），更有可能需要机械通气（67.6%对26.8%，p < 0.001）。他们在入住ICU时格拉斯哥昏迷量表评分更低（p = 0.006），急性生理与慢性健康状况评价II评分更高（p = 0.006），脑脊液葡萄糖（p = 0.004）和蛋白质水平升高（p = 0.029），自身抗体血清阴性率更高（32.4%对13.4%，p = 0.011），糖皮质激素使用更少（p =
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