Clinical characteristics and outcomes of patients with antibody-related autoimmune encephalitis presenting with disorders of consciousness: A prospective cohort study

Objective:To explore the clinical characteristics, short-and long-term func-tional outcomes, and risk factors for antibody-related autoimmune en-cephalitis (AE) in patients with disorders of consciousness (DoC).Methods:Clinical data were collected from AE patients admitted to XuanwuHospital of Capital Medical University from January 2012 to December 2021,and patients were followed up for up to 24 months after immunotherapy.Results:A total of 312 patients with AE were included: 197 (63.1%) with anti-NMDAR encephalitis, 71 (22.8%) with anti-LGI1 encephalitis, 20 (6.4%) withanti-GABAbR encephalitis, 10 (3.2%) with anti-CASPR2 encephalitis, 10 (3.2%)with anti-GAD65 encephalitis, and 4 (1.3%) with anti-AMPAR2 encephalitis.Among these patients, 32.4% (101/312) presented with DoC, and the median(interquartile range, IQR) time to DoC was 16 (7.5, 32) days. DoC patients hadhigher rates of various clinical features of AE (p< .05). DoC was associatedwith elevated lumbar puncture cerebrospinal fluid (CSF) pressure, CSF leu-kocyte count, and specific antibody titer (p< .05). A high percentage of pa-tients in the DoC group had a poor prognosis at discharge and at 6 monthsafter immunotherapy (p< .001), but no significant difference in prognosis wasnoted between the DoC group and the non-DoC group at 12 and 24 monthsafter immunotherapy. Dyskinesia (OR = 3.266, 95% CI: 1.550-6.925,p= .002),autonomic dysfunction (OR = 5.871, 95% CI: 2.574-14.096, andp< .001),increased CSF pressure (OR = 1.007, 95% CI: 1.001-1.014,p= .046), andmodified Rankin scale (mRS) score >= 3 at the initiation of immunotherapy(OR = 7.457, 95% CI: 3.225-18.839,p< .001) were independent risk factors forDoC in AE patients. Conclusion:DoC is a relatively common clinical symptom in patients withAE, especially critically ill patients. Despite requiring longer hospitalization,DoC mostly improves with treatment of the primary disease and has a goodlong-term prognosis after aggressive life support and combinationimmunotherapy.