Figure 8.

Fecal microbiota and outcomes in anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis patients. The community composition of fecal bacteria was significantly predictive of functional outcomes at 6 months. (A) Diagnostic outcomes are presented via receiver operating characteristic (ROC) curves for the outcomes at 6 months of NMDAR encephalitis patients. (B) Detailed explanatory variables that are based on random forest models for comparison of favorable and worse outcomes. Bar lengths in the histogram denote the mean decrease accuracy, showing the significance of operational taxonomic units (OTUs) for classification. Random forest identified the fecal-associated OTU512 (Granulicatella) as the strongest predictor of favorable outcome. (C) Cox proportional hazards model of the association of relapse. Patients were grouped into two: α-diversity < median and α-diversity > median, for which at least 6-month Kaplan–Meier survival plot is shown. Fifty-eight NMDAR encephalitis patients were grouped based on Shannon index median (log-rank p = 0.037, HR = 2.74, 95%CI = 1.06–7.05). Numbers below the curve represent the at-risk patients per group. Yellow line, below the median; blue line, above the median. Analyses were done using quantitative values, and grouping by quantiles was used for graphical presentation only. Patients with unfavorable outcomes did not improve microbiota abnormalities compared to patients with favorable outcomes. (D) Patients with paired baseline and long-term (6 ± 1 months) fecal samples are represented (n = 30). The measured parameters were genera OTU512. (E, F) Patients without relapse had an overall improvement of the Shannon and Chao indices over time compared to patients with one or several relapses. Wilcoxon signed-rank test for comparisons of paired baseline and long-term change.