Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.
Details
Serval ID
serval:BIB_103FDC43FE8A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.
Journal
American journal of respiratory and critical care medicine
Working group(s)
ENCEPHALITICA Study Group ‡
Contributor(s)
Allou N., Argaud L., Barjon G., Belcour D., Bouadma L., Bruel C., Bruneel F., Chabanne R., Chillet P., Choukroun G., Da Silva D., Debarre M., Dellamonica J., Ducq P., Dupont H., El Kalioubi A., Geri G., Grelon F., Griton M., Lapebie F.X., Lautrette A., Lavoue S., Louart B., Lenclud Ch, Leroy O., Mariotte E., Moschietto S., Mourvillier B., Oddo M., Preda G., Pugin D., Razazi K., Rigaud J.P., Robinet S., Siami Sh, Susset V., Taccone F., Thille A.W., Thuong M., Tiger F.
ISSN
1535-4970 (Electronic)
ISSN-L
1073-449X
Publication state
Published
Issued date
15/02/2017
Peer-reviewed
Oui
Volume
195
Number
4
Pages
491-499
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Observational Study
Publication Status: ppublish
Publication Status: ppublish
Abstract
Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients.
To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis.
This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2.
Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for <5 vs. >50 cells/mm3; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome.
The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis.
This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2.
Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for <5 vs. >50 cells/mm3; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome.
The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
Keywords
Administration, Intravenous, Adult, Age Distribution, Analysis of Variance, Anti-N-Methyl-D-Aspartate Receptor Encephalitis/cerebrospinal fluid, Anti-N-Methyl-D-Aspartate Receptor Encephalitis/immunology, Anti-N-Methyl-D-Aspartate Receptor Encephalitis/therapy, Brain/physiopathology, Female, France, Humans, Immunoglobulins/administration & dosage, Immunoglobulins/therapeutic use, Immunotherapy/methods, Intensive Care Units, Male, Neuroimaging/methods, Plasmapheresis/methods, Prognosis, Receptors, N-Methyl-D-Aspartate/immunology, Retrospective Studies, Secondary Prevention, Sex Distribution, Steroids/therapeutic use, Treatment Outcome, Young Adult, anti–N-methyl-d-aspartate receptor, critical care, encephalitis, immunotherapy, incidence
Pubmed
Web of science
Create date
22/12/2017 12:39
Last modification date
20/08/2019 13:37
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