title: Autoimmune Encephalitis at the Neurological Intensive Care Unit: Etiologies, Reasons for Admission and Survival.
abstract: BACKGROUND
  Early recognition and treatment of autoimmune encephalitis (AE) has become an essential issue in clinical practice. However, little is known about patients with deteriorating conditions and the need for intensive care treatment. Here, we aimed to characterize underlying aetiologies, clinical symptoms, reasons for intensive care admission, and mortality of critically ill patients with AE.
  
  
  METHODS
  We conducted a retrospective chart review of all patients with "definite" or "probable" diagnoses of AE treated at our neurological intensive care unit between 2002 and 2015. We collected and analyzed clinical, paraclinical, laboratory findings and assessed the mortality at last follow-up based on patient records.
  
  
  RESULTS
  Twenty-seven patients [median age 55 years (range 25-87), male = 16] were included. Thirteen (48%) had "definite" AE. The most common reasons for admission were status epilepticus (7/27, 26%) and delirium (4/27, 15%). One-year survival was 82%, all five deceased were male, and 3 (60%) of them had "probable" disease. The non-survivors (median follow-up 1 year) were more likely to have underlying cancer and higher need for respiratory support compared to the survivors (p < 0.041, and p = 0.004, respectively).
  
  
  CONCLUSIONS
  Clinical presentations and outcomes in critically ill patients with AE are diverse, and the most common leading cause for intensive care unit admission was status epilepticus. The association of comorbid malignancy and the need for mechanical ventilation with mortality deserves further attention.
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Gayane
authors.initials: G
authors.lastname: Harutyunyan
authors.affiliation: Department of Psychiatry, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Larissa
authors.initials: L
authors.lastname: Hauer
authors.affiliation: Department of Critical Care, University College of London Hospital, London, UK.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Anush
authors.initials: A
authors.lastname: Karamyan
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Tobias
authors.initials: T
authors.lastname: Moser
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Slaven
authors.initials: S
authors.lastname: Pikija
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Leitinger
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Helmut F
authors.initials: HF
authors.lastname: Novak
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
authors.affiliation: Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. j.sellner@salk.at.|Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria. j.sellner@salk.at.
authors.forename: Johann
authors.initials: J
authors.lastname: Sellner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020274:Autoimmune Diseases of the Nervous System / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy
keywords: Autoimmune encephalitis; Immune-mediated; Intensive care unit; Mortality; Status epilepticus