Risk factors for mortality in patients with anti- NMDA receptor encephalitis.

Objective Anti-N-methyl-D-aspartate receptor ( NMDAR) encephalitis is a severe autoimmune disorder with a mortality of 5%-7%, but few studies have focused on the predictors of death in this disease. In this study, we aim to investigate predictors and causes of death in patients with anti- NMDAR encephalitis. Methods In this cohort study, patients with anti- NMDAR encephalitis were enrolled at the West China Hospital of Sichuan University between June 2011 and October 2015. The outcomes of patients were evaluated by long-term follow-up. Cox regression analysis was used to assess the association between potential predictors and death. Results Altogether 96 patients were included in this study, and 11 died after median 24.5 (7-57) months of follow-up. The mortality of anti- NMDAR encephalitis was 11.46%. Multivariate analysis results showed that Glasgow Coma Scale ( GCS) score ≤8 at admission ( HR=15.917, 95% CI=1.729-146.562; P=.015), the number of complications ( HR=7.772, 95% CI=1.944-31.072; P=.004), and admission to an intensive care unit ( HR=70.158, 95% CI=2.395-2055.459; P=.014) were significantly associated with increased risk of mortality. Twelve patients received second-line immunotherapy, and the cohort was relatively under-treated compared with other studies. The main causes of death were severe pneumonia, multiple organ dysfunction syndrome, and refractory status epilepticus. Conclusion GCS score ≤8 at admission, number of complications, and admission to an intensive care unit are predictors of death. Management of complications may improve the prognosis of anti- NMDAR encephalitis. [ABSTRACT FROM AUTHOR]