Pulmonary infection and baseline mRS scores predict poor prognosis in anti-GABABR encephalitis
Junqing Ding1, Dingkang Xu2,3, Jie Lv4
1Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Purpose:
Anti-gamma-aminobutyric-acid type B receptor (anti-GABABR) encephalitis is a rare autoimmune condition caused by the presence of GABABR antibodies in the limbic system. However, its clinical features and prognostic factors are poorly understood. In this study, we aimed to explore factors that affect the response to first-line treatment in patients with anti-GABABR encephalitis.
Methods:
Thirty-four patients with an initial diagnosis of anti-GABABR encephalitis were retrospectively enrolled from December 2015 to June 2021. Clinical features and experimental data recorded within 24 h of admission were extracted from the patients' medical records. The modified Rankin Scale (mRS) was utilized to assess disease severity at admission and functional recovery after immunotherapy. Independent prognostic factors were determined by ordinal logistic regression analysis.
Results:
Of the 34 anti-GABABR encephalitis patients, 12 (35%) presented with cancer; all of these patients had lung cancer. According to multivariate regression analysis, the cancer group exhibited a decrease in the peripheral blood absolute lymphocyte count (ALC) (odds ratio [OR]: 0.063, 95% confidence interval [CI]: 0.006-0.639, P=0.019) and hyponatremia (OR: 9.268, 95% CI: 1.054-81.502, 0.045). In addition, the neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) and platelet/lymphocyte ratio (PLR) did not significantly differ according to mRS scores in patients receiving first-line treatment. No patients with mild or moderate mRS scores (0-2) at admission developed symptoms after treatment; in contrast, only 11 patients with a severe mRS scores (≥3, 11/18) experienced symptom alleviation. Ordinal regression analysis indicated that worse prognosis was associated with pulmonary infection (OR=9.885, 95% CI: 1.106-88.323, P=0.040) and baseline mRS scores (OR= 24.047, 95% CI: 3.294-175.739, P=0.002) in the adjusted model.
Conclusion:
Our findings demonstrate that pulmonary infection and baseline mRS scores are independent risk factors for poor prognosis in patients with anti-GABABR encephalitis after first-line treatment. ALC and hyponatremia are potential biomarkers for anti-GABABR encephalitis cases accompanied by lung cancer.
Insights
Pulmonary infection and high baseline mRS scores predict poor prognosis in anti-gamma-aminobutyric-acid type B receptor (anti-GABABR) encephalitis. Lower absolute lymphocyte count (ALC) and hyponatremia may indicate lung cancer in these patients.
Area of Science:
- Neurology
- Immunology
- Oncology
Background:
- Anti-gamma-aminobutyric-acid type B receptor (anti-GABABR) encephalitis is a rare autoimmune disorder.
- The clinical manifestations and prognostic factors of anti-GABABR encephalitis remain poorly understood.
Purpose of the Study:
- To investigate factors influencing treatment response in anti-GABABR encephalitis.
- To identify prognostic indicators for patients with anti-GABABR encephalitis.
Main Methods:
- Retrospective study of 34 patients diagnosed with anti-GABABR encephalitis.
- Analysis of clinical data and experimental results within 24 hours of admission.
- Ordinal logistic regression used to determine independent prognostic factors.
Main Results:
- 12 patients (35%) had lung cancer, showing decreased absolute lymphocyte count (ALC) and hyponatremia.
- Pulmonary infection and higher baseline modified Rankin Scale (mRS) scores were associated with worse prognosis.
- Patients with severe baseline mRS scores (≥3) showed limited symptom alleviation.
Conclusions:
- Pulmonary infection and baseline mRS scores are independent predictors of poor prognosis after first-line treatment for anti-GABABR encephalitis.
- ALC and hyponatremia may serve as biomarkers in anti-GABABR encephalitis associated with lung cancer.
