Clinical Study Of Mechanically Ventilated Patients With Anti-n-methyl-d-aspartate Receptor Encephalitis

Objective By comparing the clinical data of patients with anti-NMDAR encephalitis in the mechanical ventilation(MV)group and the non-mechanical ventilation(NMV)group,the clinical manifestations and outcomes of mechanically ventilated patients were explored.Methods Retrospectively collected 31 patients with anti-NMDAR encephalitis admitted to The Second Hospital of Lanzhou University from June 2015 to December 2019,then collected inpatient data of all patients.The prognosis was assessed by the modified RanKing score(mRS)at admission,at 3 months after onset,and at the last follow-up.A mRS score of ? 2 was considered a good prognosis.A mRS score of ?3 was considered a bad prognosis.Nine patients with anti-NMDAR encephalitis underwent endotracheal intubation and ventilator-assisted ventilation,so patients were divided into two groups: MV group and NMV group.Nine patients were weakly or moderately positive for CSF anti-NMDAR antibody,and 22 patients were strongly positive for CSF antibody.The patients were divided into low CSF antibody titer group and high CSF antibody titer group.The differences in clinical characteristics,test results,and outcomes were compared between the two groups.Results 1.At the first visit,13 patients with anti-NMDAR encephalitis were initially diagnosed as autoimmune encephalitis to be discharged,7 cases as mental disorder,4 cases as viral encephalitis,4 cases as epilepsy,and 3 cases as headache,cognitive impairment and fever,respectively.The accuracy of the preliminary diagnosis was about 42%.With the development of time,the total number of patients diagnosed with anti-NMDAR encephalitis increases,but the accuracy of the initial diagnosis is not significantly higher than before.2.Comparison of basic information between the MV group and NMV group: The length of hospital stay(P?=0.010)and ICU stay time(P<0.001)in the MV group were longer than NMV group,the ICU admission rate(P< 0.001)was also higher than the NMV group.There was no significant difference in gender,age,time from onset to admission,and time from onset to immunotherapy between the two groups(P?>0.05).3.Comparison of clinical characteristics between the MV group and NMV group: the proportions of patients with epilepsy(P?=0.032),status epilepticus(P< 0.001),decreased consciousness(P< 0.001),autonomic dysfunction(P?=0.007),hypoventilation(P?=0.019),hyponatremia(P?=0.017),anemia(P< 0.001),and hypoproteinemia(P<0.001)in MV group were higher than those in NMV group.The proportion of memory disturbance(P?=0.045)in the NMV group was higher than that in the MV group.There was no significant difference between the two groups in the presence of prodromal symptoms,mental behavior abnormalities and other symptoms(P?>0.05).4.Comparison of other systemic complications in the MV group and NMV group: a higher proportion of pulmonary infections(P?=0.001),urinary infections(P?=0.019),and digestive system complications(P?=0.027)were found in the MV group,there was no significant difference in the presence of asepticemia and DVT of the lower extremities(P?>0.05).5.Comparison of inspection and laboratory results between the MV group and NMV group: the platelet count(P = 0.035)of the MV group was higher than NMV group.There were no significant differences in MRI,EEG,anti-NMDAR antibody titer in serum and CSF,CRP,UA between the two groups(P> 0.05).6.Comparison of treatment and prognosis between the the MV group and NMV group: there were no significant differences between the two groups in various treatment plans,mRS score at 3 months after onset,mRS score at the last follow-up,and relapse(P> 0.05).7.Comparison of hospitalization data between the low CSF antibody titer group and the high CSF antibody titer group: there were no significant differences in demographics,clinical characteristics,test results,treatment,and outcome between the two groups(P> 0.05).Conclusion It is necessary to distinguish anti-NMDAR encephalitis from mental disease,viral encephalitis and epilepsy.Compared with the NMV group,patients in MV group were more ill and had longer hospital stays.They were more prone to have symptoms of electrolyte disturbances,anemia,hypoalbuminemia,and other systemic complications.However,after persistent immunotherapy and symptomatic treatment,good prognosis could be achieved finally.