Development and Validation of a Risk Score for Predicting ICU Admission in Adults with New-Onset Encephalitis

被引:1
作者
Habis, Ralph [1 ]
Heck, Ashley [2 ]
Bean, Paris [2 ]
Probasco, John [1 ]
Geocadin, Romergryko G. [1 ,3 ]
Hasbun, Rodrigo [2 ]
Venkatesan, Arun [1 ]
机构
[1] Johns Hopkins Univ, Johns Hopkins Encephalitis Ctr, Dept Neurol, Sch Med, 600 North Wolfe St,Meyer 6-160, Baltimore, MD 21287 USA
[2] Univ Texas Hlth Sci Ctr, McGovern Med Sch, Dept Med, Sect Infect Dis, Houston, TX USA
[3] Johns Hopkins Univ, Sch Med, Dept Neurosurg & Anesthesiol & Crit Care Med, Baltimore, MD USA
关键词
Encephalitis; Critical care outcomes; Prognosis; Clinical prediction rules; Risk assessment; CHARLSON COMORBIDITY INDEX; FAILURE ASSESSMENT SCORE; COMA SCALE; CARE; MANAGEMENT; SPECTRUM; OUTCOMES;
D O I
10.1007/s12028-024-02063-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Timely intensive care unit (ICU) admission for patients with encephalitis is associated with better prognosis. Therefore, our aim was to create a risk score predicting ICU admission in adults with encephalitis, which could aid in optimal management and resource allocation. Methods We initially identified variables that would be most predictive of ICU admission among 372 patients with encephalitis from two hospital systems in Houston, Texas (cohort 1), who met the International Encephalitis Consortium (IEC) criteria from 2005 to 2023. Subsequently, we used a binary logistic regression model to create a risk score for ICU admission, which we then validated externally using a separate cohort of patients from two hospitals in Baltimore, Maryland (cohort 2), who met the IEC criteria from 2006 to 2022. Results Of 634 patients with encephalitis, 255 (40%) were admitted to the ICU, including 45 of 113 (39.8%) patients with an autoimmune cause, 100 of 272 (36.7%) with an infectious cause, and 110 of 249 (44.1%) with an unknown cause (p = 0.225). After conducting a multivariate analysis in cohort 1, we found that the presence of focal neurological signs, new-onset seizure, a Full Outline of Unresponsiveness score <= 14, leukocytosis, and a history of chronic kidney disease at admission were associated with an increased risk of ICU admission. The resultant clinical score for predicting ICU admission had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% confidence interval [CI] 0.72-0.82, p < 0.001). Patients were classified into three risk categories for ICU admission: low risk (score 0, 12.5%), intermediate risk (scores 1-5, 49.5%), and high risk (scores 6-8, 87.5%). External validation in cohort 2 yielded an AUROC of 0.76 (95% CI 0.69-0.83, p < 0.001). Conclusions ICU admission is common in patients with encephalitis, regardless of etiology. Our risk score, encompassing neurologic and systemic factors, may aid physicians in decisions regarding intensity of care for adult patients with encephalitis upon hospital admission.
引用
收藏
页码:196 / 206
页数:11
相关论文
共 40 条
[1]  
Akavipat P, 2011, ACTA MED OKAYAMA, V65, P205
[2]   Treatment of Movement Disorder Emergencies in Autoimmune Encephalitis in the Neurosciences ICU [J].
Ali, Farwa ;
Wijdicks, Eelco F. .
NEUROCRITICAL CARE, 2020, 32 (01) :286-294
[3]   Charlson Comorbidity Index in Predicting Poor Clinical Outcomes and Mortality in Patients with COVID-19 [J].
Baris, Serap Argun ;
Boyaci, Hasim ;
Akhan, Sila ;
Mutlu, Birsen ;
Deniz, Muge ;
Basyigit, Ilknur .
TURKISH THORACIC JOURNAL, 2022, 23 (02) :145-153
[4]   State of the Art: Acute Encephalitis [J].
Bloch, Karen C. ;
Glaser, Carol ;
Gaston, David ;
Venkatesan, Arun .
CLINICAL INFECTIOUS DISEASES, 2023, :E14-E33
[5]   A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review [J].
Cardona, Magnolia ;
Dobler, Claudia C. ;
Koreshe, Eyza ;
Heyland, Daren K. ;
Nguyen, Rebecca H. ;
Sim, Joan P. Y. ;
Clark, Justin ;
Psirides, Alex .
JOURNAL OF CRITICAL CARE, 2021, 66 :33-43
[6]   The incidence and cause of coagulopathies in an intensive care population [J].
Chakraverty, R ;
Davidson, S ;
Peggs, K ;
Stross, P ;
Garrard, C ;
Littlewood, TJ .
BRITISH JOURNAL OF HAEMATOLOGY, 1996, 93 (02) :460-463
[7]   Autoimmune encephalitis A costly condition [J].
Cohen, Jesse ;
Sotoca, Javier ;
Gandhi, Shikha ;
Yeshokumar, Anusha K. ;
Gordon-Lipkin, Eliza ;
Geocadin, Romergyko G. ;
Frick, Kevin D. ;
Probasco, John C. ;
Venkatesan, Arun .
NEUROLOGY, 2019, 92 (09) :E964-E972
[8]  
Collins GS, 2015, J CLIN EPIDEMIOL, V68, P112, DOI [10.7326/M14-0697, 10.7326/M14-0698, 10.1016/j.jclinepi.2014.11.010, 10.1186/s12916-014-0241-z, 10.1016/j.eururo.2014.11.025, 10.1002/bjs.9736, 10.1038/bjc.2014.639, 10.1136/bmj.g7594]
[9]  
Diaz-Arias LA., 2019, Neurointensive Care Unit, V20, P249, DOI [10.1007/978-3-030-36548-617, DOI 10.1007/978-3-030-36548-617, DOI 10.1007/978-3-030-36548-6_17]
[10]   Predictors of Outcome in Clinically Diagnosed Viral Encephalitis Patients: A 5-Year Prospective Study [J].
Feng, Guibo ;
Zhou, Lunqin ;
Li, Feng ;
Hu, Yida ;
Wang, Xuefeng ;
Tian, Xin .
BIOMED RESEARCH INTERNATIONAL, 2020, 2020