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

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Encephalitis
Odds Ratio
Confidence Intervals
Status Epilepticus
Brain Edema
Viral Encephalitis
Thrombocytopenia
Logistic Models
Regression Analysis
Intratracheal Intubation
Mechanical Ventilators
Predictors
Intensive Care Units
Confidence Interval
Prospective Studies
Mortality

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., ... Venkatesan, A. (2013). Predictors of outcome in acute encephalitis. Neurology, 81(9), 793-800. https://doi.org/10.1212/WNL.0b013e3182a2cc6d

Predictors of outcome in acute encephalitis. / Thakur, Kiran T.; Motta, Melissa; Asemota, Anthony O.; Kirsch, Hannah L.; Benavides, David R.; Schneider, Eric B.; McArthur, Justin Charles; Geocadin, Romergryko; Venkatesan, Arun.

In: Neurology, Vol. 81, No. 9, 27.08.2013, p. 793-800.

Research output: Contribution to journalArticle

Thakur, KT, Motta, M, Asemota, AO, Kirsch, HL, Benavides, DR, Schneider, EB, McArthur, JC, Geocadin, R & Venkatesan, A 2013, 'Predictors of outcome in acute encephalitis', Neurology, vol. 81, no. 9, pp. 793-800. https://doi.org/10.1212/WNL.0b013e3182a2cc6d
Thakur KT, Motta M, Asemota AO, Kirsch HL, Benavides DR, Schneider EB et al. Predictors of outcome in acute encephalitis. Neurology. 2013 Aug 27;81(9):793-800. https://doi.org/10.1212/WNL.0b013e3182a2cc6d
Thakur, Kiran T. ; Motta, Melissa ; Asemota, Anthony O. ; Kirsch, Hannah L. ; Benavides, David R. ; Schneider, Eric B. ; McArthur, Justin Charles ; Geocadin, Romergryko ; Venkatesan, Arun. / Predictors of outcome in acute encephalitis. In: Neurology. 2013 ; Vol. 81, No. 9. pp. 793-800.
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AB - 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.

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