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Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment
OBJECTIVE: To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE). METHODS: This study was an observational multicenter registry of consecutively included patients diagnosed with A...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278855/ https://www.ncbi.nlm.nih.gov/pubmed/30568992 http://dx.doi.org/10.1212/NXI.0000000000000514 |
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author | Schubert, Julia Brämer, Dirk Huttner, Hagen B. Gerner, Stefan T. Fuhrer, Hannah Melzer, Nico Dik, Andre Prüss, Harald Ly, Lam-Than Fuchs, Kornelius Leypoldt, Frank Nissen, Gunnar Schirotzek, Ingo Dohmen, Christian Bösel, Julian Lewerenz, Jan Thaler, Franziska Kraft, Andrea Juranek, Aleksandra Ringelstein, Marius Sühs, Kurt-Wolfram Urbanek, Christian Scherag, André Geis, Christian Witte, Otto W. Günther, Albrecht |
author_facet | Schubert, Julia Brämer, Dirk Huttner, Hagen B. Gerner, Stefan T. Fuhrer, Hannah Melzer, Nico Dik, Andre Prüss, Harald Ly, Lam-Than Fuchs, Kornelius Leypoldt, Frank Nissen, Gunnar Schirotzek, Ingo Dohmen, Christian Bösel, Julian Lewerenz, Jan Thaler, Franziska Kraft, Andrea Juranek, Aleksandra Ringelstein, Marius Sühs, Kurt-Wolfram Urbanek, Christian Scherag, André Geis, Christian Witte, Otto W. Günther, Albrecht |
author_sort | Schubert, Julia |
collection | PubMed |
description | OBJECTIVE: To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE). METHODS: This study was an observational multicenter registry of consecutively included patients diagnosed with AE requiring Neuro-ICU treatment between 2004 and 2016 from 18 tertiary hospitals. Logistic regression models explored the influence of complications, their management, and diagnostic findings on the dichotomized (0–3 vs 4–6) modified Rankin Scale score at hospital discharge. RESULTS: Of 120 patients with AE (median age 43 years [interquartile range 24–62]; 70 females), 101 developed disorders of consciousness, 54 autonomic disturbances, 42 status epilepticus, and 39 severe sepsis. Sixty-eight patients were mechanically ventilated, 85 patients had detectable neuronal autoantibodies, and 35 patients were seronegative. Worse neurologic outcome at hospital discharge was associated with necessity of mechanical ventilation (sex- and age-adjusted OR 6.28; 95% CI, 2.71–15.61) tracheostomy (adjusted OR 6.26; 95% CI, 2.68–15.73), tumor (adjusted OR 3.73; 95% CI, 1.35–11.57), sepsis (adjusted OR 4.54; 95% CI, 1.99–10.43), or autonomic dysfunction (adjusted OR 2.91; 95% CI, 1.24–7.3). No significant association was observed with autoantibody type, inflammatory changes in CSF, or pathologic MRI. CONCLUSION: In patients with AE, mechanical ventilation, sepsis, and autonomic dysregulation appear to indicate longer or incomplete convalescence. Classic ICU complications better serve as prognostic markers than the individual subtype of AE. Increased awareness and effective management of these AE-related complications are warranted, and further prospective studies are needed to confirm our findings and to develop specific strategies for outcome improvement. |
format | Online Article Text |
id | pubmed-6278855 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-62788552018-12-19 Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment Schubert, Julia Brämer, Dirk Huttner, Hagen B. Gerner, Stefan T. Fuhrer, Hannah Melzer, Nico Dik, Andre Prüss, Harald Ly, Lam-Than Fuchs, Kornelius Leypoldt, Frank Nissen, Gunnar Schirotzek, Ingo Dohmen, Christian Bösel, Julian Lewerenz, Jan Thaler, Franziska Kraft, Andrea Juranek, Aleksandra Ringelstein, Marius Sühs, Kurt-Wolfram Urbanek, Christian Scherag, André Geis, Christian Witte, Otto W. Günther, Albrecht Neurol Neuroimmunol Neuroinflamm Article OBJECTIVE: To assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE). METHODS: This study was an observational multicenter registry of consecutively included patients diagnosed with AE requiring Neuro-ICU treatment between 2004 and 2016 from 18 tertiary hospitals. Logistic regression models explored the influence of complications, their management, and diagnostic findings on the dichotomized (0–3 vs 4–6) modified Rankin Scale score at hospital discharge. RESULTS: Of 120 patients with AE (median age 43 years [interquartile range 24–62]; 70 females), 101 developed disorders of consciousness, 54 autonomic disturbances, 42 status epilepticus, and 39 severe sepsis. Sixty-eight patients were mechanically ventilated, 85 patients had detectable neuronal autoantibodies, and 35 patients were seronegative. Worse neurologic outcome at hospital discharge was associated with necessity of mechanical ventilation (sex- and age-adjusted OR 6.28; 95% CI, 2.71–15.61) tracheostomy (adjusted OR 6.26; 95% CI, 2.68–15.73), tumor (adjusted OR 3.73; 95% CI, 1.35–11.57), sepsis (adjusted OR 4.54; 95% CI, 1.99–10.43), or autonomic dysfunction (adjusted OR 2.91; 95% CI, 1.24–7.3). No significant association was observed with autoantibody type, inflammatory changes in CSF, or pathologic MRI. CONCLUSION: In patients with AE, mechanical ventilation, sepsis, and autonomic dysregulation appear to indicate longer or incomplete convalescence. Classic ICU complications better serve as prognostic markers than the individual subtype of AE. Increased awareness and effective management of these AE-related complications are warranted, and further prospective studies are needed to confirm our findings and to develop specific strategies for outcome improvement. Lippincott Williams & Wilkins 2018-10-30 /pmc/articles/PMC6278855/ /pubmed/30568992 http://dx.doi.org/10.1212/NXI.0000000000000514 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Article Schubert, Julia Brämer, Dirk Huttner, Hagen B. Gerner, Stefan T. Fuhrer, Hannah Melzer, Nico Dik, Andre Prüss, Harald Ly, Lam-Than Fuchs, Kornelius Leypoldt, Frank Nissen, Gunnar Schirotzek, Ingo Dohmen, Christian Bösel, Julian Lewerenz, Jan Thaler, Franziska Kraft, Andrea Juranek, Aleksandra Ringelstein, Marius Sühs, Kurt-Wolfram Urbanek, Christian Scherag, André Geis, Christian Witte, Otto W. Günther, Albrecht Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment |
title | Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment |
title_full | Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment |
title_fullStr | Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment |
title_full_unstemmed | Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment |
title_short | Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment |
title_sort | management and prognostic markers in patients with autoimmune encephalitis requiring icu treatment |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278855/ https://www.ncbi.nlm.nih.gov/pubmed/30568992 http://dx.doi.org/10.1212/NXI.0000000000000514 |
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