Oligoclonal Bands as Predictors of Disease Severity and Prognosis in Anti-NMDAR Encephalitis

Oligoclonal bands (OCBs) are frequently observed in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, though their clinical significance remains unclear. This study explored the association between OCBs and clinical manifestations, disease severity, and prognosis in patients with anti-NMDAR encephalitis, and evaluated its potential clinical significance.

This retrospective study included 85 anti-NMDAR encephalitis cases treated at the First Affiliated Hospital of Guangxi Medical University between June 2017 and January 2024. Participants were grouped into OCB-positive (n=47) and OCB-negative (n=38) groups to analyze disease severity and prognosis. Disease severity was assessed using the Clinical Assessment Scale for Autoimmune Encephalitis (CASE) and modified Rankin Scale (mRS). Prognostic stratification using discharge mRS scores categorized patients into mild-moderate group (mRS<3) and severe group (mRS≥3), with multivariable regression analysis identifying key prognostic predictors.

The OCB-positive group exhibited more severe clinical manifestations, including severe seizure types, disturbance of consciousness, movement disorders, and a higher incidence of intensive care unit (ICU) admission. OCB-positive patients exhibited significantly elevated cerebrospinal fluid (CSF) protein levels and neutrophil percentage in peripheral blood. Additionally, OCB-positive patients showed markedly higher median scores on both the mRS and CASE scales than OCB-negative patients at all time points (admission to last follow-up). Multivariable regression analysis identified two prognostic factors of unfavorable outcomes in anti-NMDAR encephalitis: the presence of OCBs (OR 3.741, 95% CI 1.026-13.637; P=0.046) and disturbance of consciousness (OR 11.481, 95% CI 2.633-50.057; P=0.001). Furthermore, The receiver operating characteristic (ROC) curve analysis demonstrated that the combination of OCBs and disturbance of consciousness exhibited excellent predictive performance, with an area under the curve (AUC) of 0.873 (95% CI: 0.792-0.954).

OCB positivity correlates with heightened disease severity and unfavorable prognosis in anti-NMDAR encephalitis, supporting its utility as a prognostic biomarker.