title: Predictors of outcome in acute encephalitis.
abstract: OBJECTIVE
  To investigate predictors of outcome in patients with all-cause encephalitis receiving care in the intensive care unit.
  
  
  METHODS
  A retrospective analysis of encephalitis cases at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center was performed. Using multivariate logistic regression analysis, we examined mortality and predictors of good outcome (defined as modified Rankin Scale scores of 1-3) and poor outcome (scores 4 and 5) in those surviving to hospital discharge.
  
  
  RESULTS
  In our cohort of 103 patients, the median age was 52 years (interquartile range 26), 52 patients (50.49%) were male, 28 patients (27.18%) had viral encephalitis, 19 (18.45%) developed status epilepticus (SE), 15 (14.56%) had cerebral edema, and 19 (18.45%) died. In our multivariate logistic regression analysis, death was associated with cerebral edema (odds ratio [OR] 18.06, 95% confidence interval [CI] 3.14-103.92), SE (OR 8.16, 95% CI 1.55-43.10), and thrombocytopenia (OR 6.28, 95% CI 1.41-28.03). Endotracheal intubation requirement with ventilator support was highly correlated with death (95%). In addition, in those patients who survived, viral, nonviral, and unknown causes of encephalitis were less likely to have a poor outcome at hospital discharge compared with an autoimmune etiology (viral encephalitis: OR 0.09, 95% CI 0.01-0.57; nonviral encephalitis: OR 0.02, 95% CI 0.01-0.31; unknown etiology: OR 0.18, 95% CI 0.04-0.91).
  
  
  CONCLUSIONS
  Our study suggests that predictors of death in patients with encephalitis comprise potentially reversible conditions including cerebral edema, SE, and thrombocytopenia. Further prospective studies are needed to determine whether aggressive management of these complications in patients with encephalitis improves outcome.
authors.affiliation: Johns Hopkins Encephalitis Center, Department of Neurology, The Johns Hopkins University School of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Kiran T
authors.initials: KT
authors.lastname: Thakur
authors.forename: Melissa
authors.initials: M
authors.lastname: Motta
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Asemota
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Kirsch
authors.forename: David R
authors.initials: DR
authors.lastname: Benavides
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.forename: Romergryko G
authors.initials: RG
authors.lastname: Geocadin
authors.forename: Arun
authors.initials: A
authors.lastname: Venkatesan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000401:mortality; D001929:Brain Edema / Q000401:mortality; D016001:Confidence Intervals; D004660:Encephalitis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000401:mortality / Q000628:therapy*; D013921:Thrombocytopenia / Q000401:mortality; D016896:Treatment Outcome
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