Clinical features and influencing prognostic factors in patients with anti-NMDAR encephalitis: a cohort follow-up study in Chinese patients

Objectives: The clinical manifestations of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in East China and factors associated with prognosis were analyzed.Methods A retrospective study of 106 patients (58 females; 48 males) with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2019. Clinical features and factors influencing outcomes were reviewed.Results Behavioral changes were observed in 74.5% (79/106) of patients, and comprised the initial symptoms in 61.3% (65/106). Seizures were observed in 67% (71/106) of patients, and served as initial symptoms in 31.1% (33/106). A total of 54.9% (39/71) of seizures were focal seizures. More clinical symptoms were observed in female patients than in male patients ( P =0.000). Similarly, background activity (BA) with cerebrospinal fluid (CSF) antibody titers at the peak stage was more severe in female patients than in male patients ( P = 0.000). The Binary logistic regression and ROC curve analyses revealed the factors associated with poor outcomes included consciousness disturbance (OR: 4.907, 95% CI: 1.653-14.562, P =0.004; area: 65.4%, sensitivity: 44.2%, specificity: 86.5%, P =0.014 ), EEG BA (OR: 3.743, 95% CI: 1.766-7.932, P =0.001; area: 76.6%, sensitivity: 73%, specificity: 75%, P =0.000), number of symptoms (OR: 2.911, 95% CI: 1.811-4.679, P =0.000; area: 77.1%, sensitivity: 59.5%, specificity: 78.6%, P =0.000) and CSF antibody titer (OR: 31.778, 95% CI: 8.891-113.57, P =0.000; area: 83.9%, sensitivity: 89.2%, specificity: 78.6%, P =0.000).Conclusions EEG BA and number of symptoms were associated with CSF antibody titers. Consciousness disturbances, EEG BA, number of symptoms and CSF antibody titers served as predictors of poor outcomes.