Multimodal prognostication of autoimmune encephalitis: an Australian autoimmune encephalitis consortium study.
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Seery Nabil, Wesselingh Robb, Beech Paul, Broadley James, Griffith Sarah, Rushen Tiffany, Beharry James, Tan Caleb, Chiniforoush Noushin, McLaughlin Laurie, Ter Horst Liora, Forcadela Mirasol, Tan Tracie, Kazzi Christina, Nesbitt Cassie, Buzzard Katherine, Duncan Andrew, Halliday Amy, D'Souza Wendyl, Tran Yang, Van Der Walt Anneke, Skinner Genevieve, Swayne Andrew, Malpas Charles B, Brodtmann Amy, Gillis David, Taylor Bruce, Butler Ernest G, Kalincik Tomas, Seneviratne Udaya, Macdonell Richard, Blum Stefan, Ramanathan Sudarshini, Reddel Stephen W, Hardy Todd A, O'Brien Terence J, Sanfilippo Paul, Butzkueven Helmut, Monif Mastura, Australian Autoimmune Encephalitis Consortium
Аннотация
METHODS: Univariable and multivariable logistic regression analyses for predictors of a favourable mRS (i.e. mRS ≤ 2) and a composite clinical-functional outcome at 12 months were used.
RESULTS: A total of 231 patients with AE were recruited. Multivariable logistic regression identified factors predictive of reduced odds of favourable mRS at 12 months were older age (OR 0.97; 95% CI 0.95, 0.98; p < 0.001), T2/FLAIR hyperintensity on initial MRI (OR 0.27; 95% CI 0.13, 0.56; p < 0.001), RSE (OR 0.17; 95% CI 0.06, 0.52; p = 0.002) and first-line immunotherapy failure (OR 0.18; 95% CI 0.09, 0.37; p < 0.001). Anti-LGI1 antibody-mediated encephalitis relative to other subtypes (OR 4.46; 95% CI 1.55, 12.80; p = 0.006) was associated with a better 12-month mRS. We found concordant associations for a composite outcome at 12 months, with the addition of a diagnosis of definite autoimmune limbic encephalitis (AILE) predicting a poor outcome.
DISCUSSION: Older age, MRI T2/FLAIR hyperintensity, RSE and first-line immunotherapy failure predicted worse mRS and composite clinical-functional outcome at 12 months, while a diagnosis of anti-LGI1 antibody-mediated encephalitis was associated with favourable outcomes. Our data highlight acute clinical factors predictive of a more severe clinical and functional course at 12 months.