Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults
Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults
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DOI：
10.1093/cid/ciz635
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发表时间：
2020-06-01
影响因子：
11.8
通讯作者：
Hasbun, Rodrigo
中科院分区：
文献类型：
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作者：
Hansen, Michael A.;Samannodi, Mohammed S.;Hasbun, Rodrigo
背景脑炎与显著的发病率和死亡率相关，大多数患者的病因不明。评估老年患者的大型预后研究目前缺乏。我们对2000年至2017年期间来自路易斯安那州新奥尔良和德克萨斯州休斯顿的19家医院的脑炎病例进行了回顾性队列研究。共有340例确诊为脑炎的成人（年龄≥ 17岁）患者入组，其中194例（57%）病因不明。对237例（69%）和82例（24%）患者分别进行了脑脊液单纯疱疹病毒（HSV）和水痘带状疱疹病毒聚合酶链反应（PCR）。此外，在169例（49%）患者中进行了虫媒病毒血清学检查，并在49例（14%）患者中进行了抗N-甲基-D-天冬氨酸受体抗体测量。323例患者中共有172例（53%）在出院时出现不良临床结局（ACO）。老年人（>65岁）的人类免疫缺陷病毒患病率较低，合并症数量较多，不太可能接受辅助类固醇，更可能具有阳性虫媒病毒血清学，更可能具有阳性HSV PCR，更可能具有异常计算机断层扫描结果，并且更可能具有ACO（所有P值= 65，发热，格拉斯哥昏迷量表（GCS）评分
Background. Encephalitis is associated with significant morbidity and mortality, with unknown etiologies in the majority of patients. Large prognostic studies evaluating elderly patients are currently lacking.Methods. We performed a retrospective cohort of encephalitis cases in 19 hospitals from New Orleans, Louisiana, and Houston, Texas, between the years 2000 and 2017.Results. A total of 340 adult (aged >= 17 years) patients with confirmed encephalitis were enrolled, and 194 (57%) had unknown etiologies. A cerebrospinal fluid polymerase chain reaction (PCR) for herpes simplex virus (HSV) and varicella zoster virus was done in 237 (69%) and 82 (24%) patients, respectively. Furthermore, an arboviral serology was done in 169 (49%) patients and measurements of anti-N-methyl-D-aspartate receptor antibodies were taken in 49 (14%) patients. A total of 172 out of 323 patients (53%) had adverse clinical outcomes (ACOs) at discharge. Older individuals (>65 years of age) had a lower prevalence of human immunodeficiency virus, had a higher number of comorbidities, were less likely to receive adjuvant steroids, were more likely to have a positive arbovirus serology, were more likely to have a positive HSV PCR, were more likely to have abnormal computerized tomography findings, and were more likely to have to have an ACO (all P values = 65, fever, Glasgow Coma Scale (GCS) score