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Clinical and Laboratory Predictors of Poor Neurological Outcomes Following Infectious Encephalitis: Systematic Review
Thomas Johnson1, Mia Venables1, Babak Soleimani1,2
1Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Centre for Human Genetics, University of Oxford, Oxford, UK.
European Journal of Neurology
|November 26, 2025
Summary
Immunocompromised status, seizures, and low Glasgow Coma Scale scores predict poor outcomes in infectious encephalitis. Conversely, CSF leucocytosis indicates better outcomes, while elevated CSF protein suggests worse results.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Infectious encephalitis poses a significant global health threat, causing substantial mortality and morbidity.
- Understanding factors influencing neurological outcomes is crucial for patient management.
- Current knowledge on clinical and laboratory predictors of neurological outcomes in infectious encephalitis is limited.
Purpose of the Study:
- To systematically review and meta-analyze clinical and laboratory factors impacting neurological outcomes in infectious encephalitis.
- To identify key prognostic indicators for neurological recovery post-infection.
Main Methods:
- A comprehensive search of MEDLINE and EMBASE databases was conducted up to September 25, 2023.
- Observational studies reporting neurological outcomes at discharge or ≥6 months were included.
- Random-effects meta-analysis was used to pool risk ratios (RRs) for selected prognostic factors, with heterogeneity assessed using the I² statistic.
Main Results:
- Immunocompromised status, status epilepticus, and Glasgow Coma Scale < 8 were associated with poor neurological outcomes.
- Cerebrospinal fluid (CSF) leucocytosis correlated with better outcomes (RR: 0.83), while elevated CSF protein indicated worse outcomes (RR: 1.25).
- Adjunct steroid therapy showed no significant association with neurological outcomes.
Conclusions:
- This systematic review and meta-analysis is the first to investigate prognostic factors for neurological outcomes in infectious encephalitis.
- Clinical indicators like Glasgow Coma Scale and laboratory findings such as CSF protein levels are valuable prognostic markers.
- Easily accessible clinical and laboratory parameters can effectively predict neurological outcomes in infectious encephalitis patients.
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