Clinical Features And Prognostic Factors Of Anti NMDA Receptor Encephalitis

Background and purpose: Anti-N-methyl-d-aspartate(NMDA)receptor encephalitis is an anti neuronal antibody mediated inflammatory encephalopathy,in which the human body produces autoantibodies against NMDA receptor(NMDAR)in the brain,leading to neurological and / or psychiatric symptoms.In recent years,with the in-depth understanding of anti-NMDAR encephalitis and the advancement of biomarker detection methods,the diagnosis rate of the disease is increasing year by year,and it is now considered to be the most common autoimmune encephalitis after acute demyelinating encephalitis the reason.The clinical manifestations of the disease are complex and diverse,the treatment effect is different,the recovery process is long,and the prognosis is often the most concerned issue.Many of the current studies on anti-NMDA receptor encephalitis are still on case reports.In this paper,the relationship between clinical features and prognosis of anti NMDA receptor encephalitis was studied to explore the independent predictors of the prognosis of the disease,and to explore the role of NEOS sore in predicting the 1-year functional status of patients with anti NMDA receptor encephalitis.Materials and Methods: From June 2016 to April 2020,113 cases of anti NMDAR encephalitis in 5 tertiary hospitals in Fujian Province were retrospectively studied.The modified m RS scale was used to evaluate the neurological function of the patients at admission,4 weeks after admission and 1 year after follow-up.Univariate analysis was performed with the general situation,clinical manifestation,auxiliary examination,treatment plan and other clinical characteristics of the patients as variables.The variables with single factor statistical significance were included in the generalized linear mixed model.The generalized linear mixed model with binary distribution was used to determine the predictors of prognosis.Nonparametric Mann Whitney U test was used to analyze the correlation between NEOS score and prognosis.Or with 95% CI was used to measure the effect of NEOS score.Finally,receiver operating characteristic curve(AUC)and the area under 95% CI were used to evaluate the predictive ability of Neos score.Results: 113 patients(3-73 years old,median 22)were studied.There were 91(80.5%),61(54.0%)and 29(25.7%)patients with neurological dysfunction(m RS≥ 3)at admission,4 weeks of treatment and 1 year of follow-up,respectively,and 4(3.5%)patients died at 1 year of follow-up(m RS = 6 points).The independent predictors of prognosis of anti NMDAR encephalitis were admission to ICU(P =0.005;95% CI:0.72-3.95),no improvement of symptoms after 4 weeks of treatment(P < 0.001;95%CI:2.12-4.36)and no early treatment(P < 0.001;95% CI:1.12-2.97).Among them,the highest risk was that the symptoms did not improve after 4 weeks of treatment.NEOS score ≥ 3 was independently associated with poor 1-year prognosis of anti NMDAR encephalitis(P < 0.001;m RS= 3 OR= 39,95%CI:4.59-331.53;m RS=4-5 OR = 93.6,95%CI: 9.94-881.33).The AUC of NEOS score was 0.86(95% CI:0.78-0.93;P < 0.001).Conclusions: Admission to the ICU,no improvement in symptoms after 4 weeks of treatment,and no early treatment are independent predictors of poor prognosis for anti-NMDA receptor encephalitis,and the risk of symptoms not improving after4 weeks of treatment is the highest.Elevated NEOS is associated with a higher risk of 1-year poor functional status in patients with anti NMDAR encephalitis.NEOS score ≥ 3 indicates that the 1-year prognosis of anti NMDAR encephalitis is poor,which is an important predictor of the prognosis of the disease.