Predictors of outcome in acute encephalitis

Kiran T. Thakur, Melissa Motta, Anthony O. Asemota, Hannah L. Kirsch, David R. Benavides, Eric B. Schneider, Justin Charles McArthur, Romergryko Geocadin, Arun Venkatesan

Research output: Contribution to journalArticle

Abstract

Objective: To investigate predictors of outcome in patients with all-cause encephalitis receiving care in the intensive care unit. Methods: A retrospective analysis of encephalitis cases at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center was performed. Using multivariate logistic regression analysis, we examined mortality and predictors of good outcome (defined as modified Rankin Scale scores of 1-3) and poor outcome (scores 4 and 5) in those surviving to hospital discharge. Results: In our cohort of 103 patients, the median age was 52 years (interquartile range 26), 52 patients (50.49%) were male, 28 patients (27.18%) had viral encephalitis, 19 (18.45%) developed status epilepticus (SE), 15 (14.56%) had cerebral edema, and 19 (18.45%) died. In our multivariate logistic regression analysis, death was associated with cerebral edema (odds ratio [OR] 18.06, 95% confidence interval [CI] 3.14-103.92), SE (OR 8.16, 95% CI 1.55-43.10), and thrombocytopenia (OR 6.28, 95% CI 1.41-28.03). Endotracheal intubation requirement with ventilator support was highly correlated with death (95%). In addition, in those patients who survived, viral, nonviral, and unknown causes of encephalitis were less likely to have a poor outcome at hospital discharge compared with an autoimmune etiology (viral encephalitis: OR 0.09, 95% CI 0.01-0.57; nonviral encephalitis: OR 0.02, 95% CI 0.01-0.31; unknown etiology: OR 0.18, 95% CI 0.04-0.91). Conclusions: Our study suggests that predictors of death in patients with encephalitis comprise potentially reversible conditions including cerebral edema, SE, and thrombocytopenia. Further prospective studies are needed to determine whether aggressive management of these complications in patients with encephalitis improves outcome.

Original languageEnglish (US)
Pages (from-to)793-800
Number of pages8
JournalNeurology
Volume81
Issue number9
DOIs
StatePublished - Aug 27 2013

    Fingerprint

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Thakur, K. T., Motta, M., Asemota, A. O., Kirsch, H. L., Benavides, D. R., Schneider, E. B., McArthur, J. C., Geocadin, R., & Venkatesan, A. (2013). Predictors of outcome in acute encephalitis. Neurology, 81(9), 793-800. https://doi.org/10.1212/WNL.0b013e3182a2cc6d