Influential factors and predictors of anti-N-methyl-D-aspartate receptor encephalitis associated with severity at admission

Huang, Xiaoxue; Zhang, Shuang; Yan, Lulu; Yao, Tsuneyoshi; Wu, Jun

doi:10.1007/s10072-021-05060-1

Cited by 9 publications

(9 citation statements)

References 18 publications

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“…Although there were no differences in URIC, CSF IgG or fever between the two groups, the LASSO model revealed the role of these parameters in predicting infection. A recent study also revealed that fever is an independent risk factor for the exacerbation of anti-NMDAR encephalitis (28,29). Multiple parameters make better predictions of infection than one parameter alone.…”

Section: Discussionmentioning

confidence: 99%

High Dose Steroids as First-Line Treatment Increased the Risk of In-Hospital Infections in Patients With Anti-NMDAR Encephalitis

et al. 2021

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ObjectiveTo address the effects of high dose steroids on in-hospital infection and neurologic outcome in anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis patients.MethodsWe retrospectively reviewed the clinical data of anti-NMDAR encephalitis patients in West China Hospital, the Third Hospital of Mianyang and Mianyang Central Hospital between October 2011 and August 2020. The development of infections, inflammatory factors, neurologic outcome at discharge and risk factors for in-hospital infection were assessed in patients with and without high dose steroid therapy before and after immunotherapy. Least absolute shrinkage and selection operator (LASSO) regression and logistic regression models were established to assess risk factors for in-hospital infection.ResultsA total of 278 patients with anti-NMDAR encephalitis were included in the study. Thirty-four patients received high dose methylprednisolone (IVMP) therapy only, 84 patients received intravenous immunoglobulin (IVIG) therapy, and 160 patients received IVIG and IVMP therapy. Compared with the IVIG group, IVIG + IVMP group had a higher infection rate (64.38% vs 39.29%, P < 0.001), a higher incidence of noninfectious complications (76.25% vs 61.90%, P = 0.018) and a higher modified Rankin Scale (mRS) score at discharge from the hospital (3 vs 2, P < 0.001). Inflammatory indicators, including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII), were higher (9.93 vs 5.65, 6.94 vs 3.47 and 1.47 vs 0.70, respectively, P < 0.001) in the IVIG + IVMP group than in the IVIG group. Moreover, lymphocyte-to-monocyte ratio (LMR) was lower (2.20 vs 2.54, P = 0.047) in the IVIG + IVMP group. The LASSO model showed that mRS score on admission, seizure, body temperature, uric acid (URIC), cerebrospinal fluid immunoglobulin G (CSF IgG), NLR and LMR were risk factors for in-hospital infection. The prediction model exhibited an area under the curve (AUC) of 0.885.ConclusionsHigh dose steroids therapy was significantly associated with higher in-hospital infectious complication rates and a poor short-term prognosis in relatively severe anti-NMDAR encephalitis patients. The established prediction model might be helpful to reduce the risk of in-hospital infection.

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Section: Discussionmentioning

confidence: 99%

High Dose Steroids as First-Line Treatment Increased the Risk of In-Hospital Infections in Patients With Anti-NMDAR Encephalitis

et al. 2021

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“…A study of AE with small sample size (n = 34) found that NLR was significantly higher in patients than healthy controls, while patients with high levels of NLR tended to be more severe (mRS) at admission compared with AE patients with low levels of NLR (7). A study including 121 cases of NMDAR encephalitis showed that the NLR of severe patients was significantly higher than that of mild patients, and high levels of NLR were an independent risk factor for severe patients (10). Two studies on the treatment effect of AE indicated that high levels of NLR at admission were associated with first-line treatment failure, defined as an improvement in mRS score of less than 1 point after four weeks of treatment (9,36).…”

Section: Elevated Nlr and Mlr Were Independent Risk Factors For Disea...mentioning

confidence: 99%

“…A Meta-analysis in Canada showed that cancer patients with high levels of NLR tend to have a poor prognosis (6). NLR is gradually found to be closely associated with the severity and poor prognosis of AE patients (7)(8)(9)(10). Nevertheless, in these studies, patients were assessed using the modified Rankin Scale (mRS), which takes motor function as the main indicator.…”

Section: Introductionmentioning

confidence: 99%

The Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios Are Independently Associated With the Severity of Autoimmune Encephalitis

Liu

Wang

et al. 2022

Front. Immunol.

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BackgroundThe neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are biomarkers that may reflect inflammatory status in some immune-related diseases. This study aims to investigate the association of NLR and MLR with the severity and prognosis of autoimmune encephalitis (AE).MethodsA total of 199 patients diagnosed with AE in the First Affiliated Hospital of Zhengzhou University from October 2015 to October 2021 were retrospectively analyzed. The Clinical Assessment Scale for Autoimmune Encephalitis (CASE) and the modified Rankin Scale (mRS) were used to evaluate the severity of the patients at admission, and the patients were divided into mild group (CASE ≤ 4) and severe group (CASE ≥ 5) according to the CASE score. Poor prognosis was described as an mRS of 3 or more at 12 months. Binary logistic regression analysis was performed to assess risk factors for the severity and prognosis of AE.ResultsNLR and MLR of severe group were significantly higher than that of mild group. NLR and MLR were positively correlated with the CASE score (r = 0.659, P < 0.001; r = 0.533, P < 0.001) and the mRS score (r = 0.609, P < 0.001;r = 0.478, P < 0.001) in AE patients. Multivariate logistic analysis showed that NLR (OR = 1.475, 95%CI: 1.211-1.796, P < 0.001) and MLR (OR = 15.228, 95%CI: 1.654-140.232, P = 0.016) were independent risk factors for the severity of AE. In addition, the CASE score and the mRS score were positively correlated (r = 0.849, P < 0.001). Multivariate logistic analysis showed that the CASE at admission (OR = 1.133, 95%CI: 1.043-1.229, P = 0.003) and age (OR = 1.105, 95%CI: 1.062-1.150, P < 0.001) were independent risk factors for the poor prognosis of AE patients. The NLR and MLR at admission and whether they decreased after immunotherapy were not associated with the prognosis of AE patients (P > 0.05).ConclusionsNLR and MLR, readily available and widespread inflammatory markers, were helpful for clinicians to monitor disease progression and identify potentially severe patients of AE early to optimize clinical treatment decisions.

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“…First described in 2005 [ 67 ], anti-NMDAR-IgG AIE is a prototype of AIE and fulfills Koch/Witebsky’s postulates [ 26 , 49 , 68 , 69 ]. Anti-NMDAR-IgG AIE largely affects the female gender [ 48 , 67 , 68 , 70 ] and young-adult patients, with a mean age at an onset of 21 years [ 48 , 70 ]. Clinical presentation includes the subacute onset of psychiatric symptoms, memory and speech disturbances, and neurological features, such as epileptic seizures, movement disorders, autonomic dysfunction, decreased level of consciousness, and central hypoventilation [ 49 , 70 , 71 ].…”

Section: Autoimmune Encephalitismentioning

confidence: 99%

“…Anti-NMDAR-IgG AIE largely affects the female gender [ 48 , 67 , 68 , 70 ] and young-adult patients, with a mean age at an onset of 21 years [ 48 , 70 ]. Clinical presentation includes the subacute onset of psychiatric symptoms, memory and speech disturbances, and neurological features, such as epileptic seizures, movement disorders, autonomic dysfunction, decreased level of consciousness, and central hypoventilation [ 49 , 70 , 71 ]. Patients may also experience prodromal symptoms, such as viral-like disease or headache.…”

Section: Autoimmune Encephalitismentioning

confidence: 99%

Epilepsy, Immunity and Neuropsychiatric Disorders

Fortunato

Giugno

Sammarra

et al. 2023

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Several studies have focused on the emerging role of immunity and inflammation in a wide range of neurological disorders. Autoimmune diseases involving central nervous system share well defined clinical features including epileptic seizures and additional neuropsychiatric symptoms, like cognitive and psychiatric disturbances. The growing evidence about the role of immunity in the pathophysiologic mechanisms underlying these conditions lead to the concept of autoimmune epilepsy. This relatively-new term has been introduced to highlight the etiological and prognostic implications of immunity in epileptogenesis. In this review, we aim to discuss the role of autoimmunity in epileptogenesis and its clinical, neurophysiological, neuroimaging and therapeutic implications. Moreover, we wish to address the close relationship between immunity and additional symptoms, particularly cognitive and psychiatric features, which deeply impact clinical outcome in these patients. To assess these aspects, we have first analyzed Rasmussen’s encephalitis. Subsequently, we have covered autoimmune encephalitis, particularly those associated with autoantibodies against surface neuronal antigens, as these autoantibodies express a direct immune-mediated mechanism, different from those against intracellular antigens. Then, we have discussed about the connection between systemic immune disorders and neurological manifestations. This review aims to highlight the need to expand knowledge about the role of inflammation and autoimmunity in the pathophysiology of neurological disorders and the importance to early recognize these clinical entities. Indeed, early identification may result in faster recovery and a better prognosis.

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Influential factors and predictors of anti-N-methyl-D-aspartate receptor encephalitis associated with severity at admission

Cited by 9 publications

References 18 publications

High Dose Steroids as First-Line Treatment Increased the Risk of In-Hospital Infections in Patients With Anti-NMDAR Encephalitis

High Dose Steroids as First-Line Treatment Increased the Risk of In-Hospital Infections in Patients With Anti-NMDAR Encephalitis

The Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios Are Independently Associated With the Severity of Autoimmune Encephalitis

Epilepsy, Immunity and Neuropsychiatric Disorders

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