Table 1.
Clinical variables associated with poor functional outcomes at the 24-month follow-up in 139 patients with adult anti-NMDAR encephalitis.
| Variables | No. of patients (%) | Univariate analysis | ||
|---|---|---|---|---|
| Good outcome (n = 105) | Poor outcome (n = 34) | OR (95%CI) | P-value | |
| Age, mean (SD), y | 31.17 (± 14.81) | 40.68 (± 14.15) | 0.968 (0.939-0.996) | 0.029* |
| Gender (female) | 64 (61.0) | 17 (50.0) | 0.652 (0.263-1.629) | 0.355 |
| Symptoms | ||||
| Abnormal psychiatric/behaviour | 65 (61.9) | 25 (73.5) | 0.320 (0.107-0.849) | 0.029* |
| Seizures | 61 (56.5) | 17 (50.0) | 1.354 (0.544-3.336) | 0.510 |
| Dyskinesias and movement disorders | 15 (14.3) | 14 (41.2) | 0.159 (0.055-0.437) | <0.001* |
| Cognitive dysfunction | 28 (26.7) | 18 (52.9) | 0.346 (0.136-0.866) | 0.024* |
| Decreased consciousness | 23 (21.9) | 26 (76.5) | 0.106 (0.035-0.289) | <0.001* |
| Autonomic instability | 25 (23.8) | 6 (17.6) | 1.523 (0.530-5.069) | 0.457 |
| Speech disorder | 30 (28.6) | 22 (64.7) | 0.214 (0.080-0.541) | 0.001* |
| Prodromal symptoms | 36 (34.3) | 14 (41.2) | 2.782 (1.048-8.342) | 0.049* |
| Complications | ||||
| Pneumonia | 36 (34.3) | 14 (41.2) | 0.979 (0.387-2.591) | 0.964 |
| Hypohepatia | 25 (23.8) | 9 (26.5) | 0.798 (0.276-2.517) | 0.685 |
| Electrolyte disturbance | 10 (9.5) | 6 (17.6) | 0.489 (0.141-1.798) | 0.260 |
| Urinary tract infections | 22 (21.0) | 8 (23.5) | 0.704 (0.263-1.973) | 0.490 |
| Gastrointestinal bleeding | 17 (16.2) | 2 (5.9) | 4.847 (0.873-90.894) | 0.140 |
| ICU admission | 58 (55.2) | 29 (85.3) | 0.207 (0.056-0.605) | 0.008* |
| Tracheotomy | 4 (3.8) | 7 (20.6) | 0.212 (0.050-0.811) | 0.025* |
| Hospitalization days, mean (SD), d | 26.74 (± 17.70) | 33.95 (± 32.10) | 1.008 (0.993-1.032) | 0.420 |
| Relapse | 16 (15.2) | 18 (52.9) | 0.133 (0.047-0.039) | <0.001* |
| Rescue | 69 (65.7) | 27 (79.4) | 0.464 (0.141-1.305) | 0.169 |
| Status epilepticus | 11 (10.5) | 7 (20.6) | 0.951 (0.418-2.624) | 0.907 |
| Physical exam | ||||
| Meningeal irritation sign | 19 (18.1) | 8 (23.5) | 0.875 (0.306-2.740) | 0.809 |
| Pyramid sign | 20 (19.0) | 20 (70.6) | 0.200 (0.074-0.507) | 0.001* |
| Time to start of treatment after symptom onset | 0.934 (0.895-0.966) | <0.001* | ||
| Tumor | 8 (7.6) | 4 (11.8) | 0.348 (0.077-1.580) | 0.158 |
| Initial mRS, mean (SD) | 4.35 (± 0.69) | 3.85 (± 0.10) | 0.529 (0.290-0.894) | 0.026* |
| Treatments | ||||
| No use of immunotherapy | 8 (7.6) | 11 (32.4) | 0.234 (0.067,0.785) | 0.018* |
| First-line immunotherapy | 44 (41.9) | 21 (61.8) | 0.389 (0.137-1.010) | 0.061 |
| Adding second-line immunotherapy | 34 (32.4) | 1 (2.9) | 22.887 (4.645-414.634) | 0.625 |
| CSF results | ||||
| Weakly positive CSF antibody titers | 50 (47.6) | 18 (52.9) | 0.929 (0.379-2.265) | 0.870 |
| Positive CSF antibody titers | 35 (33.3) | 5 (14.7) | 1.760 (0.619-5.822) | 0.314 |
| Strongly positive CSF antibody titers | 25 (23.8) | 11 (32.4) | 0.567 (0.235-1.326) | 0.186 |
| CSF pleocytosis | 72 (68.6) | 22 (64.7) | 1.127 (0.437-2.816) | 0.780 |
| CSF abnormal protein | 38 (36.2) | 13 (38.2) | 0.860 (0.348-2.168) | 0.744 |
| CSF abnormal glucose | 15 (14.3) | 7 (20.6) | 0.910 (0.299-3.130) | 0.873 |
| CSF abnormal chloride | 6 (5.7) | 1 (2.9) | 1.576 (0.220-31.602) | 0.690 |
| Blood results | ||||
| Weakly positive serum antibody titers | 15 (14.3) | 7 (20.6) | 0.591 (0.207-1.777) | 0.332 |
| Positive serum antibody titers | 20 (19.0) | 3 (8.8) | 3.125 (0.793-20.852) | 0.151 |
| Strongly positive serum antibody titers | 4 (3.8) | 3 (8.8) | 0.970 (0.237-6.076) | 0.969 |
| Elevated leucocyte | 53 (50.5) | 15 (44.1) | 1.181 (0.485-2.921) | 0.715 |
| Elevated neutrophil | 61 (58.1) | 15 (44.1) | 1.767 (0.724-4.396) | 0.213 |
| Abnormal ECG | 22 (21.0) | 11 (32.4) | 0.762 (0.287-2.125) | 0.590 |
| Abnormal EEG | 82 (78.1) | 24 (70.6) | 1.714 (0.528-5.217) | 0.349 |
| Extreme delta brush | 29 (27.6) | 12 (35.3) | 0.785 (0.319-1.950) | 0.597 |
| Abnormal conventional MRI | 61 (58.1) | 27 (79.4) | 0.464 (0.141-1.305) | 0.169 |
*P < 0.05.
Anti-NMDAR, anti-N-methyl-D-aspartate receptor; SD, standard deviation; OR, odds ratio; ICU, intensive care unit; mRS, modified Rankin Scale; CSF, cerebrospinal fluid; ECG, electrocardiogram; EEG, electroencephalogram.
Reference interval: CSF WBC count: 0–5 × 106/L; CSF protein level, 200 – 400 mg/L; CSF glucose level, 2.5 – 4.4 mmol/L; CSF chloride level, 120 – 130 mmol/L; blood WBC count, 3.5–10 × 109/L; blood neutrophil count, 1.8-6.3×109/L; weakly positive CSF antibody titers, 1:1; positive CSF antibody titers, 1:3.2 - 1:10; strongly positive CSF antibody titers, ≧ 1:32; weakly positive serum antibody titers, 1:10; positive serum antibody titers, 1:32 - 1:100; strongly positive serum antibody titers, 1:320.