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August 27, 2013; 81 (9) Article

Predictors of outcome in acute encephalitis

Kiran T. Thakur, Melissa Motta, Anthony O. Asemota, Hannah L. Kirsch, David R. Benavides, Eric B. Schneider, Justin C. McArthur, Romergryko G. Geocadin, Arun Venkatesan
First published July 26, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a2cc6d
Kiran T. Thakur
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Melissa Motta
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Anthony O. Asemota
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Hannah L. Kirsch
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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David R. Benavides
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Eric B. Schneider
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Justin C. McArthur
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Romergryko G. Geocadin
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Arun Venkatesan
From the Johns Hopkins Encephalitis Center, Department of Neurology (K.T.T., M.M., A.O.A., D.R.B., J.C.M., R.G.G., A.V.), and Departments of Anesthesiology/Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), The Johns Hopkins University School of Medicine; Departments of Neurology, Medicine, Pathology, and Epidemiology (J.C.M.), and Department of International Health, The Bloomberg School of Public Health (E.B.S.), The Johns Hopkins University, Baltimore, MD; New York University School of Medicine (H.L.K.), New York; and Department of Surgery (E.B.S.), The Johns Hopkins Hospital, Baltimore, MD.
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Citation
Predictors of outcome in acute encephalitis
Kiran T. Thakur, Melissa Motta, Anthony O. Asemota, Hannah L. Kirsch, David R. Benavides, Eric B. Schneider, Justin C. McArthur, Romergryko G. Geocadin, Arun Venkatesan
Neurology Aug 2013, 81 (9) 793-800; DOI: 10.1212/WNL.0b013e3182a2cc6d

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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.

GLOSSARY

CI=
confidence interval;
GCS=
Glasgow Coma Scale;
HSV=
herpes simplex virus;
ICD-9=
International Classification of Diseases, ninth revision;
ICP=
intracranial pressure;
ICU=
intensive care unit;
JHBMC=
Johns Hopkins Bayview Medical Center;
JHH=
The Johns Hopkins Hospital;
mRS=
modified Rankin Scale;
NCCU=
neurosciences critical care unit;
OR=
odds ratio;
RSE=
refractory status epilepticus;
SE=
status epilepticus;
WBC=
white blood cell

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received March 16, 2013.
  • Accepted in final form May 28, 2013.
  • © 2013 American Academy of Neurology
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