title: Risk factors for mortality in patients with anti-NMDA receptor encephalitis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: X
authors.initials: X
authors.lastname: Chi
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: C
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: M
authors.initials: M
authors.lastname: Wu
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: D
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D002423:Cause of Death; D002681:China; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013226:Status Epilepticus / Q000150:complications / Q000401:mortality*; D055815:Young Adult
keywords: anti-NMDA receptor encephalitis; death causes; mortality; predictors