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Risk factors for mortality in patients with anti‐ NMDA receptor encephalitis
Author(s) -
Chi X.,
Wang W.,
Huang C.,
Wu M.,
Zhang L.,
Li J.,
Zhou D.
Publication year - 2017
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12723
Subject(s) - medicine , glasgow coma scale , anti nmda receptor encephalitis , encephalitis , intensive care unit , cohort , proportional hazards model , cohort study , pneumonia , pediatrics , surgery , immunology , virus
Objective Anti‐N‐methyl‐D‐aspartate receptor ( NMDAR ) encephalitis is a severe autoimmune disorder with a mortality of 5%‐7%, but few studies have focused on the predictors of death in this disease. In this study, we aim to investigate predictors and causes of death in patients with anti‐ NMDAR encephalitis. Methods In this cohort study, patients with anti‐ NMDAR encephalitis were enrolled at the West China Hospital of Sichuan University between June 2011 and October 2015. The outcomes of patients were evaluated by long‐term follow‐up. Cox regression analysis was used to assess the association between potential predictors and death. Results Altogether 96 patients were included in this study, and 11 died after median 24.5 (7‐57) months of follow‐up. The mortality of anti‐ NMDAR encephalitis was 11.46%. Multivariate analysis results showed that Glasgow Coma Scale ( GCS ) score ≤8 at admission ( HR =15.917, 95% CI =1.729‐146.562; P =.015), the number of complications ( HR =7.772, 95% CI =1.944‐31.072; P =.004), and admission to an intensive care unit ( HR =70.158, 95% CI =2.395‐2055.459; P =.014) were significantly associated with increased risk of mortality. Twelve patients received second‐line immunotherapy, and the cohort was relatively under‐treated compared with other studies. The main causes of death were severe pneumonia, multiple organ dysfunction syndrome, and refractory status epilepticus. Conclusion GCS score ≤8 at admission, number of complications, and admission to an intensive care unit are predictors of death. Management of complications may improve the prognosis of anti‐ NMDAR encephalitis.