Autoimmune Encephalitis at the Neurological Intensive Care Unit: Etiologies, Reasons for Admission and Survival

Abstract

BackgroundEarly recognition and treatment of autoimmune encephalitis (AE) has become an essential issue in clinical practice. However, little is known about patients with deteriorating conditions and the need for intensive care treatment. Here, we aimed to characterize underlying aetiologies, clinical symptoms, reasons for intensive care admission, and mortality of critically ill patients with AE.MethodsWe conducted a retrospective chart review of all patients with “definite” or “probable” diagnoses of AE treated at our neurological intensive care unit between 2002 and 2015. We collected and analyzed clinical, paraclinical, laboratory findings and assessed the mortality at last follow-up based on patient records.ResultsTwenty-seven patients [median age 55 years (range 25–87), male = 16] were included. Thirteen (48%) had “definite” AE. The most common reasons for admission were status epilepticus (7/27, 26%) and delirium (4/27, 15%). One-year survival was 82%, all five deceased were male, and 3 (60%) of them had “probable” disease. The non-survivors (median follow-up 1 year) were more likely to have underlying cancer and higher need for respiratory support compared to the survivors (p < 0.041, and p = 0.004, respectively).ConclusionsClinical presentations and outcomes in critically ill patients with AE are diverse, and the most common leading cause for intensive care unit admission was status epilepticus. The association of comorbid malignancy and the need for mechanical ventilation with mortality deserves further attention.Electronic supplementary materialThe online version of this article (doi:10.1007/s12028-016-0370-7) contains supplementary material, which is available to authorized users.

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

“…Furthermore, comorbidities did not affect the need for ICU admission. This contrasts our previous findings of increased probability of death among critically ill AE patients with higher Charlson’s comorbidity index ( 7 ). Potential reasons may be the more historical period (2002–2015) with limited recognition and knowledge of the condition.…”

“…The significance of the identified risk factors for ICU admission in our cohort with 17 definite and 15 probable cases of AE needs to be entertained in detail. In the present study, the proportion of patients with definite diagnosis of AE (44%) was in the range of cohorts reported in the literature ( 7 , 16 , 17 ). In this context, we need to consider that the detection of an antibody might have raised the physician awareness for poor prognosis and ICU admission.…”

“…The spectrum of clinical symptoms at presentation and acute course AE is wide, and there is clearly room for improvement regarding awareness, early recognition, and initiation of appropriate therapy ( 5 , 6 ). Early recognition enables a more focused management of complications including conditions leading to critical illness and requiring intensive care unit (ICU) admission ( 7 , 8 ). Patients with AE require ICU care for improved management of seizures, agitation, autonomic instability, and respiratory failure ( 7 , 9 , 10 ).…”

“…Early recognition enables a more focused management of complications including conditions leading to critical illness and requiring intensive care unit (ICU) admission ( 7 , 8 ). Patients with AE require ICU care for improved management of seizures, agitation, autonomic instability, and respiratory failure ( 7 , 9 , 10 ). Timely diagnosis and initiation of immunotherapy is a key prognostic factor ( 8 , 11 ).…”

“…In this study, we aimed to unravel risk factors for development of critical illness in 32 patients with AE. Characteristics of 13 study patients have been reported in a previous study ( 7 ).…”