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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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