A score that predicts 1-year functional status in patients with anti-NMDA receptor encephalitis
A score that predicts 1-year functional status in patients with anti-NMDA receptor encephalitis
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DOI：
10.1212/wnl.0000000000006783
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发表时间：
2019-01-15
期刊：
影响因子：
9.9
通讯作者：
Titulaer, Maarten J.
中科院分区：
文献类型：
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作者：
Balu, Ramani;McCracken, Lindsey;Titulaer, Maarten J.
目的建立预测抗nmda受体（NMDAR）脑炎诊断后1年神经功能的评分体系。方法对382例患者1年的详细资料和功能状况进行分析。确定与不良状态相关的因素（定义为修改的Rankin量表得分3），并将其纳入多变量logistic回归模型。该模型用于开发5分预测评分，称为抗nmdar脑炎一年功能状态（NEOS）评分。结果重症监护病房住院（p < 0.001）、治疗延迟4周（p = 0.012）、4周内临床改善不足（p < 0.001）、运动障碍（p = 0.001）、中枢性低通气（p < 0.001）、脑脊液白细胞计数升高（p < 0.001）、脑脊液蛋白水平升高（p = 0.027）和MRI异常（p = 0.002）与1年功能状态相关。在多因素回归模型中，重症监护病房入住、治疗延迟bbbb4周、4周内临床无改善、MRI异常、脑脊液白细胞计数bbbb20细胞/L是预后的独立预测因素。这5个变量各赋1分，形成NEOS分数。NEOS评分与1年后功能状态不良的概率密切相关（0分或1分为3%，4分或5分为69%，p < 0.001）。结论NEOS评分能准确预测抗nmdar脑炎患者1年功能状态。这个分数可以帮助估计诊断后的临床过程，并可能有助于确定可以从新疗法中受益的患者。
ObjectiveTo construct a grading score that predicts neurologic function 1 year after diagnosis of anti-NMDA receptor (NMDAR) encephalitis.MethodsThree hundred eighty-two patients with detailed information and functional status at 1 year were studied. Factors associated with poor status (defined as modified Rankin Scale score 3) were identified and incorporated into a multivariate logistic regression model. This model was used to develop a 5-point prediction score, termed the anti-NMDAR Encephalitis One-Year Functional Status (NEOS) score.ResultsIntensive care unit admission (p < 0.001), treatment delay >4 weeks (p = 0.012), lack of clinical improvement within 4 weeks (p < 0.001), movement disorder (p = 0.001), central hypoventilation (p < 0.001), elevated CSF white blood cell count (p < 0.001), elevated CSF protein level (p = 0.027), and abnormal MRI (p = 0.002) were associated with 1-year functional status in univariate analysis. Intensive care unit admission, treatment delay >4 weeks, lack of clinical improvement within 4 weeks, abnormal MRI, and CSF white blood cell count >20 cells/L were independent predictors for outcome in multivariate regression modeling. These 5 variables were assigned 1 point each to create the NEOS score. NEOS score strongly associated with the probability of poor functional status at 1 year (3% for 0 or 1 point to 69% for 4 or 5 points, p < 0.001).ConclusionsThe NEOS score accurately predicts 1-year functional status in patients with anti-NMDAR encephalitis. This score could help estimate the clinical course following diagnosis and may aid in identifying patients who could benefit from novel therapies.